What’s scarier than a colonoscopy?


Colorectal cancer.

Shudder. That’s the knee-jerk response that most of my patients give me when mention of their 50th birthday creeps into the conversation and I reveal that it is time for their screening colonoscopy.

Admittedly, a colonoscopy is not an experience that the overwhelming majority of the human race embraces with excitement and anticipation. Instead, it is a life event that is filled with dread, fear, annoyance, avoidance, and any other unsettling thought that you should feel free to insert here (____) like a game of Mad Libs gone terribly awry.

But importantly, this life event is life-saving. I repeat: life-saving. It is crucial to emphasize that in about 95% of people, colorectal cancer is a preventable cancer. And sadly, it is still the number two cancer killer amongst Americans today. And the question is: Why is this so?

First off, the fear of the unknown is powerful. Not knowing what to expect before, during, and after the procedure is a completely understandable concern, which is why it is so important to be well-informed, and to dispel any myths about the procedure. After having a detailed discussion about the benefits of a colonoscopy, as well as the risks of the procedure itself and the sedation we provide (unless you opt for no sedation, which of course can be done), it is then that you ought to turn to someone you trust for more information.

I always encourage my patients to talk to their friends and loved ones who have undergone the procedure to get the nitty gritty details about the goings-on of the colonoscopy, from start to finish. I find that once the procedure is over and done with, most patients will attest that it wasn’t nearly as dreadful as they anticipated. Importantly, they are relieved that despite their fears, they had it done and have been properly screened for cancer.

And I always remind patients to please spread the word about this attestation, because colonoscopies plainly and simply save lives. Not only does it allow for colon and rectal cancers to be caught early, which ensures fantastic survival rates compared to some of the other cancers people suffer from, but a colonoscopy also detects precancerous lesions called polyps. In most individuals who have been diagnosed with colorectal cancer, the cancer derived from a polyp, which on average, takes about 7 to 10 years to grow into a cancer. A colonoscopy can stop this chain of events dead in its tracks, as the goal of the procedure is to remove polyps in real time, thereby preventing a cancer from occurring. In other words, despite some of the negative press it gets, a colonoscopy is the most sensitive and specific test we have available to us to prevent colorectal cancer.

But it’s not just the fear of the colonoscopy itself. Truthfully, it’s the preparation the night prior that is the primary source of disgust and disdain. The thought of guzzling the less than palatable jug of solution is no picnic. But thankfully, studies have shown that by splitting the preparation solution into two doses, one taken the evening prior to the colonoscopy, and the remainder of the preparation the morning of the colonoscopy, makes for a safer, more effective procedure. Also, splitting the preparation allows patients to consume less volume in a given sitting. Is it the most pleasant of experiences? No. Is properly taking the preparation a necessary evil to ensure an effective and complete examination of the colon? Yes (insert expletives here). Until someone cleverly concocts a colon preparation that is refreshing and tasty, we’re sadly stuck with what we’ve got (which thankfully, has already significantly improved over the past decade or so).

With that said, the best test to prevent colorectal cancer is the one that gets done, right? So if you fear a colonoscopy with all of your might, there are alternatives available, and you should certainly discuss them with your doctor to see what is right for you. But please, if you’re getting ready to blow out those 50 candles on your birthday cake, take that day and half to dedicate your time to the preparation and that screening colonoscopy in order to help yourself and your loved ones. Importantly, if you have a family history of a 1st degree relative with colorectal cancer or colon polyps, talk to your doctor about getting screened, because you should be screened earlier than the average-risk individual.

And remember, as scary as a colonoscopy may seem, and as unpleasant as you think the preparation for it may be, think about the risks and worry that come with the very real potential alternative to not getting screened – being diagnosed with colorectal cancer. Now that’s scary.

Sophie M. Balzora is a gastroenterologist and can be reached on Twitter @SophieBalzoraMD.


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