Are they necessary/a good idea or a scam? I’m curious if anyone knows much about them and colon cancer in general as I’ve read conflicting reports about them,–and lots of other medical procedures–and I wonder if they’re worth the 
discomfort.
Am I asking for medical advice? No, I’ve already got that from my pcp, just curious what people think about colonoscopies in general. There are so many medical tests these days, and they get more numerous and expensive by the year.
Much less uncomfortable than dying of colon cancer. They found four polyps in me last time, and so caught it early enough to be no problem.
Grandfather, mother and a cousin all dead of colon cancer. Had my first one at age 40 due to family history. Five hyperplastic pylops, five adenomatous pylops and a large adenomatous mass. Much rather find this at 40 and get them removed then find the cancer in my 50s. Are they worth it, you bet. Saved my life. No real discomfort in the proceedure, just drinking the stuff for the prep that sucks.
Worth the effort if you have risk factors or symptoms, or are over 50. I have had two and they’re no big deal. You just have to fast and take a laxative with large amounts of liquid the night before that flushes out your digestive system. Not fun but not like it’s painful. You are sedated for the procedure itself. My doctor told me to get one every 5 years (I’m over 50 with no special risk factors).
I would be interested in the conflicting reports you’ve read, as everything I’ve read is very consistent.
I am looking forward to the day when a simple blood test will predict with high accuracy whether you have colon cancer or a dangerous precancer (as opposed to “ordinary” adenomatous polyps which pose no threat). Until then, colonoscopies remain the gold standard for colon cancer prevention.
With good premedication, colonoscopies are painless (or if they are, you won’t remember it). An early death or prolonged coping with effects of colon cancer (including the risk of a permanent colostomy or serious surgery complications) are far, far worse.
Not only colon cancer (which can be detected without a colonoscopy) but it will detect polyps that could become cancerous in the future. Also, it’s used to diagnose diverticulosis, which, while not usually life threatening, requires steps to be taken to prevent diverticulitis.
As others mentioned, the actual procedure is no problem: you’re asleep the whole time. It’s the night before, when your system is being cleaned out. Even that isn’t as bad as most people imagine.
Well, I had one as a “while we’re at it” afterthought - I was having stomach symptoms, needed an upper GI, said to the doc “I’m 50 now, can we go ahead and do the screening colonoscopy then as well?”.
And found several precancerous lesions. As the doc said “Well, I wouldn’t have wanted you to go another 5 years with those”.
I have no idea why one would think of colonoscopies as a scam. They’re not getting pushed on people younger than 50 (unless they have a family history or other issues). They are proven to reduce the incidence of a person developing full-on colon cancer. They’re generally harmless (aside from mechanical risks such as perforation, or harm from sedation, both of which are extremely rare) unlike, say, routine X-rays which pose some cumulative issues if you get too many of 'em in a lifetime.
They have a bad rep because of the prep. Seriously, aside from the IV placement (I have crappy veins and was literally dreading the IV more than anything else about it), there’s nothing else unpleasant aside from the prep itself.
The preps are cruel, there’s no other word for it. And doctors aren’t as proactive in prescribing the less-vile alternatives (anyone still routinely ordering GoLytely should, from what I’ve been heard, be shot).
Oh hells yes. We have a friend who postponed his first “age 50 screening” a couple years too long. Wound up having 12 inches of his colon removed a few months back as a result. Another friend’s husband is in the process of dying from rectal cancer - two surgeries, and right now he’s doing chemo as a palliative (to buy more / better time).
Same here. The idea that the procedure is a “scam” is pretty laughable.
Thank goodness, since they’ve helped us dramatically increase the average life expectancy.
As others have noted, routine colonoscopies play a role in this by, among other things, early detection of colorectal cancer. That’s a disease that claims 50,000 lives in the US each year. If caught in an early, non invasive stage, survival rate is virtually 100%. If not detected until it metasticizes, survival rate is 5%.
Colonoscopies aren’t all that uncomfortable. Prep is mildly annoying but you sleep through the procedure itself. Better than a trip to the dentist, IMO, or even some days at work 
“Scam” is a little harsh, but the vast majority are pointless. The overall lifetime risk for a person with no risk factors of developing colorectal cancer is 5-6% (maybe 15% if you have a first degree relative who had had it). So, for every one person you might catch, there are 17-20 people who had no need for the procedure. But, if you’re that one person, you’ll have a different outlook for sure.
My doctor mentioned that statistically colonoscopy might be questionable. Many people are saved, but the effect on a large population is an added year of life on average. (IIRC that was the gist of his explanation)
It’s a good point. With any kind of screening test, there’s the tradeoff between cost and benefit. Say you spit into a test tube, they run some fancy-dancy new test that costs 100,000 dollars, and if you’ve got a specific variety of Old Movie Disease which will kill you next month if untreated, they can treat it (at the cost of 1 million bucks), and cure you. If you’re 30 years, let’s say that might buy you 50 years of life (if something else doesn’t kill you first).
Trouble is, it’s so rare that only one in a million people get Old Movie Disease.
So to screen a million people, you spend 100 billion dollars, and get 50 more life-years out of the process. Therefore you’re spending 2 billion dollars per increased life-year.
Now, if you’re that one in a million guy (and I’m sure you are ;)), that’s a pretty damn good payoff. For the other 999,999 people, they (or their insurer, or the government) have paid 100 grand and gotten nothing.
That’s a silly example, but it’s the sort of thinking that goes into deciding on recommendations for things like colonoscopy, mammograms, etc. They weigh the cost versus benefit, and the risks. And the tradeoffs between early detection (faster, cheaper treatment and improvement in quality of life) and later detection (longer, more expensive treatment, diminished economic output, etc.).
If that spit-in-a-tube test cost ten dollars, they’d be more likely to do it on everyone even with the remote likelihood of finding a case of OMD. If OMD merely predisposed you to getting painful hangnails versus killing you, they would be less likely to cover even the 10 dollar test. If it hit one in 1,000 people and made them develop severe headaches, that’s increased risk but decreased negative outcome if untreated, so they weigh that.
Things like screening for PKU (on newborns) would seem to fall into the 10 dollars / kill you next month category. While PKU isn’t terribly common, it’s common enough - and the results if untreated devastating enough, and the test is cheap enough, that they do it on all babies.
Some arguments against things like routine screens for various types of cancer are that yeah, if you’re that one in a million, it’s worth it - but the tests themselves may pose danger (radiation, anesthesia etc.), and they may precipitate other interventions (breast biopsy etc.) that themselves carry risks. There are number crunchers out there that try to produce figures that balance that out: screening cost, likelihood of finding something, cost for follow-on tests, economic losses from those (time off work, injuries, etc.), versus benefits (1/1000 helped, lets that 1/1000 work an extra 10 years, etc.).
I assume that with colonoscopy, that 1 extra life-year is an average over all people screened? As in, you screen 1,000 people, 50 are found to have problems, and by treating it each of those 50 are expected to live 20ish years longer than if they hadn’t been screened? If the colonoscopy were done 10 years earlier, maybe only 10 people would have problems, each of those would gain an extra 35 years, so 350 years / 1000 people is .35 years gained. If it were done 10 years later, 110 people would have problems, each would gain 6 years (less gain because things had 10 years more to progress), or net gain of 660 years, or .66 years gain.
Obviously I’m making those figures up - I’m not any kind of statistician - but they seem to illustrate the conundrum.
I’d like to thank everyone for their answers, as I didn’t expect so many, so fast, and for there to be so much agreement on the matter. I guess the pain (mostly discomfort) is worth it.
JB
My FIL died of colon cancer. Recently I had a colonoscopy, and my wife has never felt better.
There have been numerous threads already on this board about colonoscopies and the preparation for them. You should be able to search them up easily.
The general consensus on this board seems to be: The procedure is no sweat, but the prep is obnoxious.
I’ve read up on it on other message boards also, where there seemed to be a consensus that the preparation is absolute hellatious gruesome torture!!!. Or, just to add a bit more emphasis: !!! Others merely note, as Mama Zappa did above, that GoLytely is gawd-awful.
Forgive me in if fall into out-of-control rant mode for a moment . . .
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Here’s my problem: My hospital requires that I have a driver bring me in and take me home, and that driver must remain at the hospital for the whole duration of the procedure. No, I can’t take a cab. No, I can’t call that custom door-to-door bus service they have for disabled people. (ETA: Dial-A-Ride.) No, they can’t arrange transportation for me.
Problem for me is: No, I don’t have anyone in my life in this city or county I can ask to drive me. I literally don’t have a single acquaintance in town, beyond a few superficial ones like apartment manager. I had an appointment last year that I had to cancel because I didn’t have a ride (and to be sure, I didn’t try too hard at the time because I was too anxious about all I had read about the prep). If I tried to re-schedule now, I have no idea who I’d ask for a ride.
[/rant]
I’m in exactly the same boat, my friend, was hoping to be able to walk or take a bus to the hospital, but if I need to be accompanied to and from the procedure I’m in a bad place. There’s one person I know who can pick me up, no one who can drive me, sit there for nearly five hours, then take me home.
But the cost of letting the cancer go is far more than 20X the cost of the colonoscopy, and the impact on a person is even more than that, so he RoI is pretty positive. I wouldn’t think there are any tests which come back mostly positive.
It’s a bit bizarre that they require the person to be there the entire time. I guess it’s CYA in case you say “yeah, my buddy will be here”, they do the procedure, and you say “I LIED, I’M DRIVING HOME”.
And the paperwork from my place is contradictory: you can take a medical transport if it’s pre-arranged and you can’t have someone with you, OTOH you must have someone with you. And it implies they just need to be there at the end (hah).
There are folks on the board who’ve said they’ve done it without sedation for this very reason, and it wasn’t too awful. Not something I’m eager to try.
5 hours is a bit extreme. I’m typically there for 2ish hours all in all. Half an hour or so in the waiting room. Another 20-30 minutes pre-procedure (paperwork, IV etc.). 20-30 minutes for the procedure (I guess). Half an hour or so afterward to recover, have something to drink etc.
GoLytely: I’ve never actually experienced that one. I’d heard so many horror stories about it that I flat out demanded the pill-based prep (Osmo-Prep). I’m thinking that the next time around though (yeah, I’ve had 4 and it’ll be an annual treat from here on out) I’m going to insist the doc let me do the Gatorade / Miralax version. I’ve done the research and that’s basically Movi-Prep, except less-gross-tasting, and I can do the math to make sure I get at least that much PEG (polyethylene glycol) and electrolytes.
The reason being: I’m finding that OsmoPrep is, well, “the gift that keeps on giving”. 5-6 hours the night before. The morning of (you take half the night before and half the morning of the procedure)… I’ll think it’s done, I’ll be waiting in the waiting room, and have to dash to the bathroom there. Repeatedly. And afterwards as well - the first thing I eat after I get home results in a not-fast-enough dash.
So, it’s either switch to a different version, or wear Depends before, and eat a bowl of soup while sitting on the damn toilet afterward. Blech.
As far as a driver: why not post here on the Dope? Ask if someone in your area might be willing to help you out. People have done that kind of thing before.
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Problem for me is: No, I don’t have anyone in my life in this city or county I can ask to drive me. I literally don’t have a single acquaintance in town, beyond a few superficial ones like apartment manager. I had an appointment last year that I had to cancel because I didn’t have a ride (and to be sure, I didn’t try too hard at the time because I was too anxious about all I had read about the prep). If I tried to re-schedule now, I have no idea who I’d ask for a ride.
My problem exactly. My last (and only) one I had a friend take me, and in return I took him later.
Now I’m by myself, the VA hospital is 80 miles away, so I’m up shit creek.(So to speak)
I had two colonoscopies, now, and my problem with them is that I am on coumadin (blood thinner). Discontinuing coumadin before the procedure, and starting it up again afterward is not a trivial procedure - it involves giving myself injections and other delights. I am eager to for a non-invasive colonoscopy procedure to be approved. Supposedly, one is on the horizon now, and just needs to get fully tested to make sure it is as effective as the conventional procedure.