March 14, 2000
“It’s time. You’re over 50,” my internist said casually during my routine physical in November.
“I’m sure you don’t want to hear this, but you really should have a colonoscopy. Is there colon cancer in your family?”
“Actually, there was,” I answered. “My maternal grandmother had it late in life.”
“Then this is no longer elective,” he added decisively. “You have to do it.”
Great. Another invasive procedure. I already had multiple sclerosis, with my share of ordeals by procedure, steroid injections under my eyes and catheters snaked through arteries from my groin to my brain. I didn’t particularly want to participate in this next adventure. I just wanted to be indemnified against another disease.
So now it would be the tush test. A television camera inserted into my rectum. The closer I came to the appointed hour with the gastroenterologist, the more I realized my utter horror was increasing and was out of proportion. What’s wrong with this picture?
Colonoscopies save lives. They can detect colorectal cancer early. Most malignancies in the colon begin as benign polyps. Only one in four people will have a polyp, which can be removed painlessly during the procedure before it ever becomes malignant. The only colonoscopy with an uncertain outcome is the first. There is no way to know in that situation what is growing and how long it has festered before being discovered.
My story, precisely. A polyp was removed and no one thought much of it. Over 90 percent are benign. It was biopsied, and I learned I had a malignancy. It took four hours of surgery and a resected colon, but soon enough the cancer was gone.
I was left with a sore lower back from the incision and a powerful sense of how lucky I was. The cancer was found early. The colonoscopy had saved my life. I realized, though, how close I had come to postponing, if not altogether ignoring my internist’s advice.
During the pre-op work-up, I had asked my 69-year-old internist with the unequivocal advice when he had last subjected himself to the dreaded procedure.
“I’ve never had one,” he muttered.
“Why?” I asked, not even trying to mask my incredulity.
“Stupidity. Denial,” he admitted. “I want to be a doctor, not a patient.” Then, he added, “I’m going to get one next month.”
Never has a single procedure, a test that can save lives been greeted by more resistance, indeed repulsion. Colon cancer is the second leading cancer killer in America. Contrary to popular belief, it hits both genders as an equal opportunity killer. Undergoing a colonoscopy every five years, three, if there is a family history, is practically a fail-safe guarantee against the disease. Yet many people don’t want any part of the procedure.
“It’s a shame. People don’t know what colonoscopies are about today,” said Dr. Blair Lewis, a gastroenterologist at Mount Sinai. “They’ve changed. It’s not like the old sigmoidoscopies, which were blunt instruments examining the lower colon. People don’t understand that today the instrument is flexible and the whole thing is painless.”
It is painless. I know that now. A cocktail of sedatives takes the edge off the discomfort, which is more in our heads than in our rumps anyway. There are no pain receptors in the colon, and you can watch the event progress on a television monitor at no extra charge. The pictures seemed almost impressionist, very color intensive to me. Maybe it was the drugs. Only slight abdominal pressure registered, but the truth is, our phobias are all about the instant of entry, the long anticipated, awful anal invasion that makes grown men cringe.
Face it. Guys are wimps. Women are used to routine medical invasion. Alas, it is their lot in life. By the time a woman hits 50 and heads for the doctor, earlier if there is a family history, she has been probed and prodded in every orifice. Women who have borne children should laugh at such male distress. When Colonoscopy Claus comes down the chimney, women may not jingle bells, but they seem to sigh and embrace him.
“I just did it.” says Neen Hunt, executive director of the Lasker Foundation, which supports medical research. “My mother died of colon cancer, and I had my first colonoscopy when I was 40. I’m now 57, and I’ve had a few more. It’s too important to my family not to do it.”
My mother, Terry Cohen, a retired registered nurse and staff instructor, has had three colonoscopies and a few sigmoidoscopies before that. “I didn’t have any particular anxieties about them. I wasn’t happy, but I just did it. As a woman, I’ve been through worse than that. I was just concerned about the outcome.”
Her outcome was just fine, but that doesn’t seem to be what is on the minds of men. Jim Hightower, former agriculture commissioner of Texas and author of “If the Gods Had Meant Us To Vote, They Would Have Given Us Candidates” (HarperCollins), stopped by for lunch recently. I talk about this stuff with everyone these days.
Jim is 57 and has yet to undergo the procedure. “My father died of colon cancer,” he said, shaking his head. “I know I should have one.”
With colon cancer in the family, any person’s risk of acquiring the disease doubles by age 40. For those people, resisting colon cancer screening is playing Russian roulette. Jim claims he watches his diet and eats fiber regularly and, yes, is going to get a colonoscopy. “I’m going to do it. I just haven’t gotten there yet.”
The most common method of colon cancer screening is flexible sigmoidoscopy because it is now covered by Medicare. It is not adequate in more than 50 percent of the applications, though, because it does not reach the upper colon. So, colonoscopy remains the probe of choice. The modern, flexible sigmoidoscopy is less intrusive, but still there is resistance. The American College of Gastroenterologists runs a never-ending advertising campaign with the warning, “People will die of embarrassment.” Beyond embarrassment, the mere thought of these procedures touches on a common fear of invasion with many men.
“Fear of the procedures and the failure of doctors to adequately explain them are the problem,” explains Dr. Philip Schoenfeld, director of gastroenterology research at the National Naval Medical Center in Bethesda, Md. Personally, I think it is the failure of Americans to just grow up. While there are no firm numbers, researchers estimate that only about 15 percent of people over 50 get colonoscopies.
Look. These tush tests stink. You have to drink hemlock and pour your guts out in preparation for the blessed event. It is sort of like the morning after going to a bad ethnic restaurant. But clean intestines are happy intestines.
Insurance hassles never end, if you are lucky enough to be insured at all. Carriers go out of their way to cut costs, of course, and they can make screening colonoscopies almost impossible to obtain. Usually, the procedure is covered only when there is cause. But the bottom line, so-to-speak, is that these procedures are just not fun.
Whoever said that fighting cancer should be fun?