Wednesday, April 23, 2014
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The good and bad news about colonoscopy screening

The night before a colonoscopy is no fun. After drinking a bowel-clearing solution that sparks your own private "Blazing Saddles" bean-eating-campfire scene, your colon is cleansed and all set for its "Mr. DeMille, I'm ready for my close-up" moment.

The good and bad news about colonoscopy screening

File photo of Dr. Pedro Jose Greer, right, preparing to do a colonoscopy at Mercy Hospital in Miami.  Researchers are searching for a way to do a less invasive screening. (AP Photo/Lynne Sladky)
File photo of Dr. Pedro Jose Greer, right, preparing to do a colonoscopy at Mercy Hospital in Miami. Researchers are searching for a way to do a less invasive screening. (AP Photo/Lynne Sladky)

The night before a colonoscopy is no fun.

After drinking a bowel-clearing solution that sparks your own private Blazing Saddles-bean-eating-campfire scene, your colon is cleansed and all set for its “Mr. DeMille, I’m ready for my close-up” moment.

The next morning, at the gastroenterologist’s office, you’ll be prepped and sedated, and a colonoscope -  a long flexible tube with a video camera at its end -  will be inserted into your anus to examine the inner lining of your rectum and large intestine. If polyps or other abnormal tissue are found during the procedure, the doctor can remove them for biopsy.

This may sound awful, but it’s worth it. A study released last week in the New England Journal of Medicine confirms what had previously been conventional wisdom: colonoscopic removal of polyps saves lives, cutting the death risk from colon cancer by more than 50%.

Previous studies had shown that the detection of early-stage colon cancer through fecal blood tests reduced death-rates from colon cancer. That makes sense; the detection of and surgical removal of early-stage colon cancer prevents the disease’s spread and saves lives.

But nobody had systematically studied whether the removal of precancerous or adenomatous polyps reduced death from colorectal cancer. The new study seems to put that question to rest. Colonoscopies really do save lives.

Unfortunately, the economic downturn has been curtailing rates of colonoscopy, even among the insured. This troubling finding seems to be related to the out-of-pocket (OOP) expenses incurred even among the insured.

According to a recent study, “those with high OOP procedure costs had lower screening rates over time, and experienced a greater decrease in screening rates during the recession.” That study’s authors argue “for strategies to reduce patient cost sharing for colorectal cancer screening.” The Patient Protection and Affordable Care Act – the  federal health-care overhaul - eliminates Medicare and Medicaid “copayments and deductible requirements for all preventive services recommended by the United States Preventive Services Task Force, including screening colonoscopy.” Private insurers have yet to do the same.

If you are 50 or older, the Centers for Disease Control and Prevention (CDC) recommends screening for colorectal cancer. If you have a family history of colon polyps or cancer, you have inflammatory bowel disease, or you have a colon-related genetic syndrome then you may need to be tested earlier. The CDC provides free- or low-cost colorectal cancer screening as part of its Colorectal Cancer Control Program (CRCCP).

The CDC recommends calling your local health department to find out more about colorectal screening or to call 1 (800) 4-CANCER or 1 (800) ACS-2345 to find out more about your screening options.


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About this blog

What is public health — and why does it matter?

Through prevention, education, and intervention, public health practitioners - epidemiologists, health policy experts, municipal workers, environmental health scientists - work to keep us healthy.

It’s not always easy. Michael Yudell, Jonathan Purtle, and other contributors tell you why.

Michael Yudell, PhD, MPH Associate Professor, Drexel University School of Public Health
Jonathan Purtle, MPH Doctoral candidate and Research Associate, Center for Nonviolence and Social Justice, Drexel University
Janet Golden, PhD Professor of history, Rutgers University-Camden
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