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Tuesday, January 21, 2014

Baby Boomers Embracing Colonoscopies

April 23, 2013

After starving herself for two days, Lori Linder of Corcoran savored cream of mushroom soup. James Koci of Wausau, Wis., went for extra-crispy KFC. Robbe Christensen of Farmington walked across the street for a Butter Burger and fries from Culver’s.

One of the most satisfying meals of their lives was a just reward after enduring a procedure that’s as daunting as it is effective: a colonoscopy.

The baby boomer generation — 8,000 of whom turn 50 every day — is embracing this dreaded procedure. The mere talk of a colonoscopy used to be taboo. For some boomers, it feels like an unwelcomed rite of passage that means they’ve reached old age. But health experts have ramped up the conversation, using new tactics to persuade patients that it’s worth the discomfort. While there’s still push-back, the chatter — combined with an aging populace — has put the procedure in the spotlight like never before.

The Minnesota Department of Health is confronting the issue with a series of billboards, including a risqué, anatomically impossible one, which has to be seen to be believed. On Sunday, runners will be out in full force for a 5K fundraiser in Edina called Get Your Rear in Gear, sponsored by the nonprofit Colon Cancer Coalition.

The message: These things work. Sixty percent of colorectal cancer deaths could have been prevented with proper screening.

“Colonoscopies are probably the best tool we have for finding and treating a cancer,” said Dr. Anne Pereira, an internist at Hennepin County Medical Center. “Among prostate, breast and colon screening, colon is the one we do the best job with … because it’s so easy to treat. People shouldn’t die from colon cancer.”

Even so, it’s still difficult to get some people to care. Pereira said only about two-thirds of her patients follow through on colonoscopy recommendations. Even among those who seem fully committed, Minnesota Gastroenterology has about 1,000 “no shows” every year.

But 60,000 do show up.

For some, it starts with overcoming a common mental roadblock: the combination of turning 50 and being told they need to have this done. Pereira tries to address the anti-aging brigade’s concerns by telling them, “You’re old enough to need it, but that doesn’t mean you’re old.”

Fear and loathing

Men are a particularly tough sell.

“Women, in general, buy into the concept that ‘Even though it’s unpleasant, it’s good for me,’ whereas men are less convinced of that argument,” Pereira said.

Her compatriot, Dr. Aaron Brosam, who performs colonoscopies at HCMC’s Gastroenterology Clinics, agreed.

“A colonoscopy for a man is usually the most invasive thing that happens to him,” he said. “Women have had a lot [of pap smears, mammograms, etc.]. And giving birth, you lose a lot of modesty in that process.”

Pereira cited three “primary barriers” that people confront when committing to a colonoscopy: the preparation, the exam and the sedation.

Anne Carlson, executive director of the Colon Cancer Coalition, listed three slightly different barriers. “People are scared of the prep. They’re scared of the cost. And honestly, they’re scared of having cancer.”

Being scared of the disease, of course, is a good reason to get a colonoscopy. Colon cancer is the second-leading cause of cancer death in the United States, and these screenings can reduce colon cancer by two-thirds, Brosam said. The five-year survival rate is 67 to 74 percent for stage I, IIA and IIIA, according to the American Cancer Society.

Still, less than 40 percent of Americans with health insurance are getting screened, Carlson said.

The procedure vs. the prep

The details of the examination are well known: Doctors send a tube with a camera into the colon to detect and remove potentially pre-cancerous growths called polyps.

“With colon cancer, we know how to screen for it, we know exactly how to find it and we know how to treat it,” Carlson said. “And it’s the only cancer that basically waves at you with the polyps and says, ‘Hey, I’m about to turn into cancer, but if you pluck me out that won’t happen.’ Polyps are your friends.”

Oftentimes, the procedure isn’t the most worrisome part. It’s what comes before. When he sees a patient on examination day, Brosam tells them “they’ve been through the worst part.”

The preparation involves a day or more of consuming nothing but water and a liquid laxative. Minnesota Gastroenterology’s Lisa Belak said that most patients prefer a Gatorade-type sports drink, “but it is not universal. Many still use the ‘big jug’ or packet preps.”

3-D colonoscopy?

There also are noninvasive alternatives to the traditional procedure. A new test called Cologuard, developed by a Wisconsin company, examines stool samples for DNA anomalies. The new screening method awaits FDA approval.

Another test, called a colonography, is basically a virtual colonoscopy. This procedure uses X-rays and computers to produce two- and three-dimensional images of the colon. But even with this alternative, Carlson noted, “you still have to do the prep, and if they find a polyp, they still have to go in there.”

Beyond the alternatives, Brosam said it’s simply easier these days to assure patients that getting one is a good idea. He cited publicity, including Katie Couric’s live colonoscopy on “The Today Show,” and word-of-mouth.

“More people have done it, so it’s not as much a taboo as it used to be,” Brosam said. “They know somebody who’s had it before. And we have more data now saying that it does good things for you. So people are more eager.”

Some people get their motivation from experience.

“My brother and I are diligent,” said Jean Peterson of Shoreview, “because we saw our grandfather die from colon cancer, avoiding the doc until it was too late. It’s a sneaky bugger.”

Peterson, by the way, is not one of those patients who had a major food craving after her two colonoscopies. “I really hated to eat a thing, even though I was famished,” she said. “it just felt good to be so whistle-clean. That said, a glass or two of my favorite white wine was in order.”

For Brosam, even more common than the cravings is the potty humor that comes along with getting a colonoscopy. Most of these risqué quips are, of course, not suited for a family newspaper, but Brosam said that perhaps the most oft-heard jape comes from men:

“You can tell my wife that you didn’t find my head in there.”

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