The American Cancer Society (ACS) recommends a colonoscopy for everyone beginning around age 50. The purpose of the screening procedure is to look for existing colorectal cancer or signs the disease might develop. Additional colonoscopies are recommended thereafter at 10-year intervals, assuming no problems are discovered. At the ACS website, the procedure is called “uncomfortable and invasive” and suggests “someone drive you home after the procedure.” Preparation for colonoscopy requires “cleaning of the bowel” using a special diet and laxatives for a day before the procedure. There are several potential complications associated with a colonoscopy, including perforation, bleeding and death, again according to the American Cancer Society. The most common complication is perforation, occurring roughly once in every 1,000 procedures, according to a 2009 review published in “Genetics in Medicine.” Death occurs in every 12,500 procedures.
There are other, less invasive options for colorectal cancer screening, including virtual colonoscopy and stool tests, such as fecal immunological tests or fecal DNA. Of course, these are not what American doctors call “the gold standard.” A colonoscopy is the gold standard.
A colonoscopy involves the insertion of a thin, tube-like instrument equipped with a small camera called a “colonoscope” (what else-a periscope?). This mini-dildo-like device is inserted up the rectum where it is threaded throughout the entire colon. The colonoscope enables a visual diagnosis of any incipient colorectal cancer and a biopsy and removal of suspicious lesions. If no lesions are found, suspicious or otherwise, two things happen before the device is removed while the patient is still under sedation: 1) The doctor who performed the procedure is given enough time to get out of town and begin a new life under a government witness protection-like program; and 2) When the drugs wear off and the patient is fully revived, a skilled counselor says something like this to the patient: “Sorry, we did not find a thing wrong with you. You really did not have to go through this. Your colon is fine. Come back and see us again in ten years. We’ll do this to you again.”
No, I’m just kidding-I made that up because here is the really amazing truth of the matter: The patient has been prepared for this highly probable eventuality! And he went through with it, anyway. He is not gobsmacked to learn that it was for naught-he would have been fine if he skipped the whole thing. All he has is some reassurance that he does not have this particular disease or likely to get it soon. There are still hundreds of others laying in wait for the passage of time. How many more tests will he have to learn that he does not have one of them? In any case, this is what he actually hoped to be told about the results of the colonoscopy. At this point, the patient is not only expected NOT to seize the throat of the medicos who did this to him but, on the contrary, he has been programmed to be happy about it all. Thus, he is likely to say something like this: “Oh, thank you so much. Thank you, thank you. I am sooo delighted. You people are the best. I can hardly wait till you do it again to me in ten years.”
I have never paid much attention to what the ACS or other medical organizations recommend concerning one test or another. I have been wary of medical tests, checkups, preventive examinations, risk assessments and all such medical imprecations. There is way too much of this. Such activities have been a part of the medicalization of health for at least half a century. I became aware of the problem as a health planner beginning in the late 60’s. I was immersed in medical policy and research for five years before transitioning into my current role of wellness promoter. I have a Ph.D. in health and public policy. I saw up close and personal the reality and the wasteful, often dangerous consequences of our bloated, dysfunctional medical system. I have written extensively about it.