Colonoscopy: nothing to fear from the 'silver stallion'

I recently had a colonoscopy, an invasive medical procedure to examine the bowel, and was hugely relieved to get the all-clear. I posted a description of my experience to my friends on Facebook and got a range of responses.

Among the bad puns about me having “updated” my status and many thumbs up, were some that indicated people misunderstood why anyone would have a colonoscopy. Some close friends also muttered comments that it was tacky to post about such intimacies.

People have colonoscopies for a range of reasons, including looking for signs of bowel (colorectal) cancer.

Bowel cancer is Australia’s second biggest cancer killer after lung cancer, claiming the lives of 4,162 people every year, nearly 95% of whom are aged 50 years or more. A total of 14,958 people were newly diagnosed with the disease in 2013. Both men and women are at risk of developing bowel cancer, with a split of around 55% male and 45% female.

But compared to some more high profile (mainly female specific) cancers, bowel cancer has long suffered a far lower profile than its prevalence, impact and potential for early intervention warrant.

Why isn’t bowel cancer mentioned on TV?

Bowel cancer barely makes it on the TV news when you compare how common it is. Our 2010 research showed bowel cancer news reports accounted for 4.1% of all news reports about cancer but bowel cancer represents 13.5% of newly diagnosed cancers and 11.5% of cancer deaths.

Compared to cancers receiving greater TV news coverage, there were hardly any reports of celebrity diagnoses, and mention of bowel cancer advocacy groups.

At that time, the national colorectal screening program, which began in 2006, received limited coverage. Breast cancer received 13 times the number of reports than did colorectal cancer.

Reports produced to support planning for the national campaign highlighted the importance of celebrities prepared to discuss their conditions in the media to raise awareness of breast cancer. In contrast, no celebrities were then known to be involved in bowel cancer publicity. There were also no special high-profile appeals, awareness weeks or advertising campaigns.

This is changing with efforts such as celebrity bowel cancer ambassadors and greatly increased publicity being driven by the national campaign and cancer councils.

Factors known to stop people taking part in bowel cancer screening mainly relate to procrastination and its perceived unpleasantness. Then there’s the fear of discovering a potentially fatal illness; fatalism (beliefs that there’s not much you can do about it if you’ve got it); no symptoms and/or family history of the disease; and squeamishness about getting stool samples.

Given some of my friends’ reaction, the importance of participation in bowel screening, and on-going challenges in getting higher rates of participation in screening, I thought I’d walk readers through what’s involved.

It started when I turned 50

I had my first colonoscopy when I turned 50, along with some other minor repair work. The surgeon said:

We’ll use the opportunity to take a look inside you.

Thankfully, I was clear of problems.

One memory was how far anaesthesia had advanced since my unpleasant memories of the ether-soaked mask descending over my face when I had my appendix removed in the early 1960s.

Another memory was the unexpected greeting a bunch of medical students, who were about to cast their wide eyes on my nether regions, gave me in the prep room. One bubbled in the seconds before I went under:

Hey! Hello Prof Chapman!

Oh great.

At 65, I was perhaps overdue for a second encounter. The death of a neighbour in his 50s and two colleagues diagnosed with bowel cancer in recent years gave me no hesitation when the trigger of a mailed invitation and kit from the National Bowel Cancer Screening Program to have a faecal occult blood test (FOBT) arrived.

My stool sample was positive (it contained blood), as are the results for about one in 14 people who take an FOBT test. But there are many reasons other than cancer for blood in the stool. I take a low-dose aspirin tablet every day, which can cause intestinal bleeding, and that may have been responsible.

A letter arrived strongly urging I book a colonoscopy. I’d be renewing my acquaintance with the “silver stallion”, as proctologists sometimes call it.

Watch what you eat, purge, repeat

I booked in for a Tuesday. Over the weekend I was told to eat no fibre, with Monday being the “purgatory” day. From waking, you can eat nothing but water, then 2-8pm you drink three sachets of purgative. I’ve drunk more foul brews (castor oil, as a child), but not many. I found the best strategy was to re-imagine myself in my undergraduate days, sculling a schooner of beer, mentally block out the thought of the taste, and just keep swallowing.

About an hour after the first sachet you begin your impersonation of a human fire hydrant. By the end of the evening, your newly svelte correspondent had lost 2.5kg.

My appointment was for 9am. I joined about 12 others of a similar vintage, some with supportive partners stroking their hands. I then discovered there was one final, by far the worst, purgative.

I was made to sit in a waiting room for about three hours watching commercial morning TV. This was an endless advertorial gushing about vacuum cleaners, kitchen slicers and stain removers. Watching this stuff would be enough to give anyone the trots.

A view from both ends

When it was my turn, I got into the backless gown with a rear neck tie and waited on the trolley bed. A very pleasant nurse came to insert the cannula for the anaesthetic in my hand and explain what lay ahead.

She noted I was also having an endoscopy to check my throat and stomach after I’d had a reflux incident. In case I might have wondered, she assured me:

We don’t use the same camera.

I was, apparently, in a classy establishment.

I looked at my watch as I was wheeled in, and again when I woke up afterwards. Some 20 minutes had passed. And within a minute or so, the doctor was at my beside with the news I was clear of any problems in both ends.

I dressed, was picked up and went to a Vietnamese restaurant where I murdered a giant bowl of beef pho, ravenous. The next day I drove from Sydney to Melbourne, fully alert and comfortable.

To me, the procedure itself was an utter non-event. Serious complications like bowel perforation are rare. The voiding is just a “grit your teeth and get on with it” exercise that you quickly forget. But the peace of mind afterwards is wonderful.

Lives saved

Last month The Lancet published results from the longest follow-up study of people screened for bowel cancer.

Researchers followed 170,034 people for a median 17.1 years, some screened once with sigmoidoscopy, which is like a colonoscopy but doesn’t go as deep into the bowel, and others who had not had sigmoidoscopy.

After adjusting for non-compliance such as study drop-outs, the number of new cases of bowel cancer were reduced by 35% in the group that had had a single sigmoidoscopy versus the control group; deaths from bowel cancer were reduced by 41%.

This is another ringing endorsement for early intervention.

The Cancer Council Australia recommends people over 50 years have a FOBT test every two years. People in The Lancet report only had one sigmoidoscopy. But FOBT can show evidence of asymptomatic bleeding that you may have never noticed, allowing early life-saving intervention.

Bowel Cancer Australia provides extensive information and answers to frequently asked questions about the disease and the screening program.