Update: Colonoscopies are recommended starting at age 45. I'm about to turn 51, so...


Over at STAT News, Nicholas St. Fleur and Hyacinth Empinado have an interesting piece about why he (St. Fleur) gave himself a colonoscopy for his 30th birthday:

The passing of Chadwick Boseman from colorectal cancer at the age of 43 devastated so many people who looked to the “Black Panther” star and saw a hero. His death last year was particularly impactful for me, a young Black man whose mother had been diagnosed with the disease at age 34.

My mom was fortunate. She had a colonoscopy that spotted the cancer early and helped save her life.

Still, because of my family history, I am at an increased risk of developing colorectal cancer. Black men are also at higher risk as well. So just days before my 30th birthday, I underwent my first colonoscopy.

I'm not black, but I am about to turn 51 years old, and it's well past time for me to get my first colonoscopy to screen for colorectal cancer (the recommendation used to be to have your first screening when you turn 50, but more recently this was moved up to age 45). As it happens, I'm scheduled to get my first colonoscopy tomorrow morning.

From the U.S. Preventative Services Task Force:

To whom does this recommendation apply?

Adults 45 years and older who do not have signs or symptoms of colorectal cancer and who are at average risk for colorectal cancer (ie, no prior diagnosis of colorectal cancer, adenomatous polyps, or inflammatory bowel disease; no personal diagnosis or family history of known genetic disorders that predispose them to a high lifetime risk of colorectal cancer [such as Lynch syndrome or familial adenomatous polyposis]).

How to implement this recommendation?

Screen all adults aged 45 to 75 years for colorectal cancer. Several recommended screening tests are available. Clinicians and patients may consider a variety of factors in deciding which test may be best for each person. For example, the tests require different frequencies of screening, location of screening (home or office), methods of screening (stool-based or direct visualization), preprocedure bowel preparation, anesthesia or sedation during the test, and follow-up procedures for abnormal findings.

Recommended screening strategies include:

  • High-sensitivity guaiac fecal occult blood test (HSgFOBT) or fecal immunochemical test (FIT) every year
  • Stool DNA-FIT every 1 to 3 years
  • Computed tomography colonography every 5 years
  • Flexible sigmoidoscopy every 5 years
  • Flexible sigmoidoscopy every 10 years + annual FIT
  • Colonoscopy screening every 10 years

From everything I've heard and read, the procedure itself is fairly commonplace and pretty low-risk; it involves exactly what you'd expect:

A colonoscopy is an exam used to detect changes or abnormalities in the large intestine (colon) and rectum.

During a colonoscopy, a long, flexible tube (colonoscope) is inserted into the rectum. A tiny video camera at the tip of the tube allows the doctor to view the inside of the entire colon.

If necessary, polyps or other types of abnormal tissue can be removed through the scope during a colonoscopy. Tissue samples (biopsies) can be taken during a colonoscopy as well.

The only real risks are having an allergic reaction to the sedative (I'm not allergic to any that I know of), bleeding from the spots where they take tissue samples or remove polyps, or the off-chance that they tear your colon wall during the process (very rare).

The bigger deal is preparing for the procedure...which involves having to clear out your entire system. And that, my friends, is the fun part:

To empty your colon, your doctor may ask you to:

Follow a special diet the day before the exam. Typically, you won't be able to eat solid food the day before the exam. Drinks may be limited to clear liquids — plain water, tea and coffee without milk or cream, broth, and carbonated beverages. Avoid red liquids, which can be confused with blood during the colonoscopy. You may not be able to eat or drink anything after midnight the night before the exam.

Take a laxative. Your doctor will usually recommend taking a laxative, in either pill form or liquid form. You may be instructed to take the laxative the night before your colonoscopy, or you may be asked to use the laxative both the night before and the morning of the procedure.

In my case (it may vary for some folks), I was given very specific instructions for today:

  • No solid foods
  • Clear liquid breakfast, clear liquid diet all day
  • I can drink Gatorade, bouillon, chicken broth, lemondade, Jell-O, apple juice, white grape juice, coffee, tea, pop, popiscles (not red or purple), iced tea..but nothing red or purple, and no dairy products.
  • At 2pm and 4pm I have to take Dulcolax tablets with 12 oz of clear liquid
  • Starting at 5pm I have to take a mix of 64 oz of clear Gatorade and 238 grams of Miralax

Needless to say, I'm in for a pretty miserable day...but it's a hell of a lot better than the alternative.

At full price, colonoscopies typically cost around $2,800 on average nationally. Fortunately, under the Affordable Care Act, colorectal screenings are required to be 100% covered by most insurance plans at $0 out of pocket cost to the enrollee, along with a long list of other preventative services.

UPDATE: Several fellow healthcare wonks have noted that while the screening itself may be free, if they actually find any polyps or have to take a tissue biopsy, that may involve a co-pay/deductible charge just like any standard medical procedure depending on your insurance. Something to keep in mind.

Also, I should clarify that the screening is only free if you have it performed at an in-network facility (by in-network doctors), and that your insurance has to be ACA-compliant (i.e, if you have non-ACA coverage like a "short-term" plan, farm bureau plan, sharing ministry plan etc, you may have to pay for it, as well as if you're uninsured at all, of course).

Unfortunately, as I wrote about last week, Yet Another ACA Lawsuit® threatens to remove this coverage requirement. So, if anyone reading this is 45 or older and hasn't already done so, I strongly recommend having yours done as soon as possible.

UPDATE x2: I'm happy to report that not only did the procedure go smoothly, they didn't find any polyps or other issues to be concerned about, which means unless there's some other development before then, I don't have to go through this again for another ten years.

Any time I have an invasive medical procedure of any sort (regardless of how routine) I like to give a shout-out to the doctors & nurses involved. This is even more important at the moment, given the hell that healthcare workers of all sorts have gone through over the past year and a half (remember, the anti-mask/anti-vaxx protesters don't care what type of healthcare professional you are; they've been harrassing all types).

With that in mind, I want to thank Dr. Damadi, Dr. Stanton, and RNs Diane, Michele, Cindy, Val, Ellen and Christina (at least I think they were all nurses...a couple might have been aides/trainees?) of the Michigan Endoscopy Center at Providence Park in Novi, Michigan for their stellar work yesterday. Everyone did a great job and I appreciate it.