Lakeview providers address common colonoscopy concerns, fears, and questions.

It is estimated that about 1 in 24 people will develop colorectal cancer at some point in their lifetime, and colonoscopies are the best preventative measure currently available. “The only people dying from colon cancer, are the people who are not getting a colonoscopy” states Lakeview Physician, Dr. Paul Brown. Despite this, many people choose not to follow the advice of their medical provider when they are told to have a colonoscopy screening.

There are a variety of reasons people avoid or delay getting colonoscopies, even though they are an important tool for detecting colorectal cancer and other gastrointestinal issues.  A panel of Lakeview Clinic medical providers has addressed many of these reasons below in an effort to persuade patients to have this important screening and potentially save lives.

I have no family history of colon cancer; is a screening necessary?

 “Current recommendations for colonoscopy in patients without family history begins at age 45,” states Dr. Todd Elftmann. Colorectal cancer can develop without noticeable symptoms, and early detection is crucial. According to Dr. Timothy Thormodsgard, “The majority of colon cancer cases occur in people with no family history of colon cancer, so screening is important even if you have no family history.”

Isn’t it possible that polyps aren’t cancerous?

Knowing whether a polyp in benign (non-cancerous) is critical to preventing colon cancer. “The only way to know which type of polyp you may have is to do a colonoscopy. Additionally, the polyp can usually be removed during the procedure, which will prevent it from becoming a cancer” states Dr. Thormodsgard.

“Not all polyps are harmful but monitoring them closely can help prevent colon cancer and save your life” explains Dr. Heidi Wuerger. If no polyps are found, the study should be repeated in 10 years.

What if polyps are found?

Dr. Elftmann explains, “we do not always know which polyps we encounter will actually become cancer. Therefore, [polyps] will be removed and sent to a pathologist. The pathologist will determine if the polyp is pre-cancerous, and recommendations regarding appropriate follow-up will be made.” If adenomatous polyps are found, the study will likely need to be repeated in 3-5 years depending on the number and type of polyps found.

I’ve heard polyps can be missed. If so, why even get a colonoscopy?

Dr Thormodsgard explains, “there is a risk that a polyp will not be seen during the colonoscopy. Research has shown that nearly 17% of polyps can be missed during the exam. However, that means that over 80% of polyps are found and treated during the exam. The polyps that are missed are almost all less than 1 centimeter in size. Additionally, the risk of missing colon cancer during a colonoscopy is very low, around 2-3%. Because we know that some polyps are at risk of developing into colon cancers, and that this transformation happens slowly, getting a colonoscopy is still the best way to prevent colon cancer.

I am nervous about complications.

Dr. Todd Elftman outlined complication rates as follows: “Complications include bleeding are 8 in 10,000; colon perforations are 4 in 10,000, and the risk of death is 3 in 100,000.” In comparison, “the risk of death in a car accident is approximately 1 in 100.” In addition to complications being very rare, they are also treatable. According to Dr. Heidi Wuerger, “if a perforation and bleeding do happen, there are good means to help treat these complications.” It also bears mentioning that, according to The American Cancer Society, the rate of developing colon/rectum cancer is 1 in 24 for males and 1 in 26 for females.

I’m terrified of anesthesia. What can alleviate this concern?

Colonoscopies take about 20 minutes and are typically done with conscious sedation “In general, the anesthesia used for a colonoscopy is very safe. Your vital signs will be closely monitored throughout the procedure” stated Dr. Thormodsgard. Dr. Wuerger added that patients “could do a small pre-medication, if needed.”

Do colonoscopies hurt?

According to Dr. Brown, “people may have mild discomfort during the procedure and for a day or so afterwards.” “Patients usually will not remember any discomfort during the procedure due to the sedative medications,” adds Dr. Elftmann.

How bad is preparation for a colonoscopy?

“The colonoscopy preparation is usually the worst part for about 95% of patients. However, if the preparation is taken as instructed, most patients tolerate the preparation quite well and without issues. Some patients experience nausea and vomiting, but this is usually due to patients trying to rush the oral intake rather than following the timing of oral intake in the directions they receive. I recommend giving yourself plenty of time the evening before and the morning of the colonoscopy to complete the preparation,” explains Dr. Elftmann.

If I am diabetic, will preparing for a colonoscopy be hard on me?

Be sure to talk with your primary medical provider about any concerns. They are your go-to for advice regarding safely preparing for a colonoscopy. Whether it is adjusting medications or recommending different insulin doses, they are best equipped to assist you. Additionally, “you are able to consume a clear liquid diet before, during, and after your bowel preparation. This will allow you to maintain your glucose intake and levels,” adds Dr. Elftmann.

How much time will I need to take off of work?

Typically, one day is needed. “You will need to begin your bowel preparation in the early evening the day before your colonoscopy and will need to take the day off for your colonoscopy. Most people are back to normal activities without restrictions the day following their procedure,” explains Dr. Elftman.

Why not just do a Cologuard test instead?

Put simply, “it is less sensitive and if positive, you will require a colonoscopy anyway,” states Dr. Brown. “Unfortunately, there are numerous limitations to the Cologuard test. The test can miss up to 8% of colon cancers and 42% of polyps, giving a false negative result,” adds Dr. Thormodsgard. Dr. Elftmann says another way to look at it is “Cologuard will not detect a colon cancer when present approximately 8% of the time and will not detect an advanced pre-cancerous polyp when present approximately 58% of the time.” When early detection is so important in saving lives, these numbers really matter.

Some patients may have health or medical statuses that prevent them from undergoing a colonoscopy. Cologuard is an option for these patients.

Does insurance cover colonoscopies?

We always recommend verifying coverage with your insurance company prior to having any procedure, but in general, colonoscopy screenings are considered preventative and therefore covered. However, if the patient has any gastrointestinal symptoms, or your doctor finds a polyp or mass needing biopsy, your colonoscopy is then considered diagnostic, and your coverage may change. Patients may be required to pay a deductible or coinsurance for a diagnostic colonoscopy.

Colonoscopies are the gold standard colorectal cancer screening option. All of the general surgeons at Lakeview Clinic perform colonoscopy and are able to treat many of the cases of colorectal cancer discovered during the exam. You can schedule a colonoscopy online or request a screening on our website.

We want to thank our panel for taking time to help educate patients about this potentially lifesaving procedure!

• General Surgeon, Todd Elftmann, MD
• General Surgeon, Timothy Thormodsgard, MD
• Internal Medicine Physician, Paul Brown, MD
• Family Medicine Physician, Heidi Wuerger, MD