I had intended to repost this slightly icky piece during March, which is designated as Colorectal Cancer Awareness Month. A number of people thanked me when it first appeared in 2018 because it reminded them to have the colonoscopies they’d been putting off.
There’s even more reason to repeat it now. Early detection is critical, and too many people either couldn’t get their routine colonoscopies done because facilities were closed due to Covid—or have delayed after the procedures were once again available because they feared going into medical settings.
Hundreds of thousands of fewer breast, colon, and cervical cancers screenings were performed in 2020, reported the Epic Health Research Network. Oncologists believe the result has been they’re seeing patients with these diseases at more advanced, less curable, stages.
And the reason I originally felt a sense of urgency to write this piece has only become more heightened. The increase in colon cancer in younger people has reached what one oncologist called “alarming” rates.
Whereas age 50 used to be the screening recommendation, it’s been reduced to 45—and that’s if you have no family history or other risk factors.
Recall the tragic death of Chadwick Boseman, the tremendously gifted actor who won fame as the Black Panther and has been posthumously nominated for an Oscar for his role in “Ma Rainey’s Black Bottom.” Boseman was diagnosed with colon cancer at age 39 and died at 43.
Black Americans are far more likely to develop colon cancer, but it is now the third most commonly diagnosed cancer in the US in both men and women.
Rates had been dropping due to screening and lifestyle changes. That’s why the increase in younger people makes early detection especially important—as is catching up on those delayed colonoscopies for those over 45.
And please don’t forget to pay attention to the other routine screening tests—such as mammograms—that are critically important as well.
Here’s my attempt to inject a little lightheartedness into a difficult topic about a life-saving procedure.
Wanna Hear About My Colonoscopy?
Probably not. If you’re reading this, you are either a) one of my very loyal readers, in which case I am most grateful for your perseverance; b) interested in all things medical, no matter how icky; c) a catastrophizer like me, who always goes to the darkest possibility in terms of health; or d) just plain curious to find out what this strange woman is up to.
Why do I want to tell you about my colonoscopy? March is Colorectal Cancer Awareness Month, so I figure if Katie Couric could have had a colonoscopy live on the Today Show in 2000 (after her husband died of colon cancer in 1998), it doesn’t take much courage to write this post for my blog. She also accompanied Jimmy Kimmel to his first colonoscopy, and you can find that amusing and instructive episode in this YouTube video.
The purpose, of course, is to encourage screening among those who either don’t think about it or just can’t bring themselves to do it. Colonoscopy screening is one of the indisputable ways to save lives. But even if you have one regularly, I hope you’ll continue to read this because I’ve learned some important information that I don’t think is widely known, and perhaps you can spread the word to others. As Jane E. Brody, who writes the Personal Health column in The New York Times, stated:
“Although I usually refrain from columns linked to national health observances, I believe that Colorectal Cancer Awareness Month, in March, is too important to ignore. There are simply too many people who are still getting and dying from this preventable disease because they failed to get screening for it, including people with no excuse like ignorance, lack of health insurance, or poor access to medical services.”
I am close to two people who have lost loved ones to colon cancer in their early 50s. One was a beloved childhood friend; the other a treasured younger brother. Although any young death is a tragedy, both of these people were terrific, warm, loving individuals who left grieving spouses and children—and whose deaths were totally preventable.
In addition, I think about the vibrant young woman, mother of two, whom I met when I took a mindfulness-based stress reduction course last year. She had had colon cancer once, had a recurrence, but was then doing well, she said. Her purpose in taking the course was to find a way to ease her anxiety while she awaited subsequent test results. She wept briefly as she described her circumstances, regained her composure, and for the rest of the eight-week course, was a delightful, wry person who dealt silently with what must have been a huge psychological burden. I think of her fondly, hoping her health is stable.
Here’s the important point that I’m not sure is well known: Last year, the American Cancer Society (ACS) lowered the proposed age for first screening (for people with no known risk factors or family history) from 50 to 45. That’s because so many younger people have been struck with the disease.
And 45 probably isn’t low enough. In contrast to a drop in the overall death rate, attributable to greater detection and removal of precancerous polyps, an ACS study found that since the 1980s, colorectal cancer rates have increased by 1.0% to 2.4% each year in those aged 20-39, and since the 1990s, by 0.5% to 1.3% among those aged 40-55. Oncologists are seeing the disease even in adolescents. Those statistics should make us all sit up and take notice.
It’s not clear why these rates are increasing, writes Patricio Polanco, MD, of the UTSouthwestern Medical Center. He and others say the factors considered include genetic mutations, low fiber diet, obesity, smoking, heavy drinking, and ulcerative colitis.
But conflicting conclusions emerge from other reputable sources. In a 2018 discussion among experts in an OncLive Peer Exchange, Michael Morse, MD, of Duke University Hospital said the data suggest neither obesity nor mutational differences are significant. He suggests “something environmental or habit-based…but until we can collect enough data from a large enough number of people, I just don’t see how we’re going to tease it out.”
This is clearly a societal issue that requires greater awareness on the part of the public. Primary care physicians may need additional education as well, experts have suggested. As there’s no screening for those under age 45, younger people with questionable symptoms may have no time to waste, as noted below.
In my case, as an adherent patient and catastrophizer, there was no way I’d procrastinate in having the procedure right when I was told I should: at age 50. That first one was fine, but the next one showed a few polyps, as did the following one. And since one polyp was precancerous, I was advised to have another colonoscopy after only three years. I’ve never had root canal, so I can’t use that comparison, but for the uninitiated, the experience is neither a walk in the park nor the worst thing imaginable.
The instructions are that three days before, one should eat only cooked fruits and vegetables. That eliminates about 2/3 of my diet, so right there, I’m at a disadvantage. No blueberries in my morning cereal; no huge salad with dinner, containing five or six of my favorite veggies; not even a small banana. For some reason, a line from Carl Reiner and Mel Brooks’ “2000-Year-Old Man” came to mind: “I’d rather eat a rotten nectarine than a fine plum.” I would have been happy with either—or both.
On the Day-Before-the-Day, I started the liquid diet. Fantastic options there: broth, apple juice, Jello (but nothing red, the only flavors I like), soda, coffee (neither of which I drink), sherbet (but not with milk and also not red, precluding my favorite raspberry). So using a wellspring of creativity, I came up with my day’s menu:
Breakfast: mug of chicken broth, glass of apple juice
Lunch: mug of chicken broth, glass of apple juice
Dinner: mug of chicken broth, glass of apple juice
Dinner was at 3 pm, because at 4 it was time to begin THE PREP.
As many of you may know from experience, the prep involves imbibing a truly noxious-tasting substance—a combo of ingredients designed to flush the system, in my case with a soupçon of lemon-lime flavoring to tickle the palate—all mixed with luke-warm water and then refrigerated, allegedly to make it more palatable.
Suffice it to say, I got a lot of exercise over the next several hours running back and forth until my system was “clean as a whistle.” That’s all the scatology I’m going to inflict upon you.
On The Day, fortunately, my appointment was at 7:30 am. All the medical history review and pre-procedure steps went smoothly.
Then, with the anesthesia dripping into my vein and oxygen in my nose, I drifted off. What was probably 10 minutes later, I was awake. (The electronic schedule board in the waiting room had shown that my gastro had already done 4 of these before my arrival, and had 2 more in the works before he got to me.) I lay there for a few minutes, chose my post-procedure food and drink—cranberry juice and a blueberry muffin—finished them off in a nanosecond, and that was that.
The news was better than the last time: one small polyp, the gastro informed me—definitely not cancerous; he could tell that clearly. Tonight, just minutes before publishing this post, I got a call from the gastro telling me the biopsy report showed that the polyp wasn’t even precancerous. And because there was only one small one, I now have a five-year respite from this procedure, rather than only three years. So hooray for that!
I am telling you all this in the hope that it will be beneficial. In terms of cancer deaths in the US, colorectal cancers come in second; this year, according to Jane Brody, 51,000 people are expected to die of the disease.
In addition to colonoscopy, there are less complex tests available; see Jane Brody’s column for a description of them. Colonoscopy, though, is considered the best test, as it can both detect cancer and remove polyps that may well develop into full-blown cancer in time.
The fact that an increasing number of those cancer deaths occur in people in their 20s, 30s, or 40s weighs heavily on me. Polanco, of UT Southwestern Medical Center, says it’s important for young people to be aware of the symptoms: abdominal pain, blood in the stool, constipation, diarrhea, decreased appetite, and weight loss, “and never assume they’re too young to get colorectal cancer.”
Younger people tend to attribute their symptoms to something less serious, he writes, such as hemorrhoids or irritable bowel syndrome, and therefore don’t seek medical help until they have late-stage disease. Though I don’t want to generate panic on this issue, it is clear that changed circumstances require a new mindset to better protect younger adults. And the rest of us need to do the prudent thing to protect ourselves as well.
As always, I welcome your opinions, insights, stories, additional sources. And thank you for staying with me to the end of a post on a topic that I really didn’t want to write about at all, but felt compelled to do so.