Over 50? Had a Colonoscopy Yet?

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It’s kind of a rite of passage for those over age 50. Even those who’ve sworn they will never discuss their medical affairs publicly have been known to ask,  “Have you had your colonoscopy yet?”

While 50 is the suggested age for the first screening for people of average risk (those with a family history, inflammatory bowel disease or previous polyps may be encouraged to start earlier), only about 50% of those over 50 undergo it. That’s a shame, because colon cancer is 90% preventable if detected in the early precancerous stages.

People trade stories on the vicissitudes of the cleansing preparation, but while it seems an onerous test to face, colon cancer kills more than 50,000 people a year and is the second leading cause of cancer death for both men and women. A friend of mine, who never had a colonoscopy, faced serious chemotherapy and surgery at 70. It’s made the rest of us glad we’d followed the rules.

In case you haven’t heard, the preparation involves downing a gallon of yucky flavored solution, or a lesser volume of a more potent drink, or taking some pills and then spending a lot of time in the bathroom. I swore I’d go for the pills next time, as drinking the cold liquid every hour for eight hours left me shivering. (And keeping it cold really doesn’t help the taste!)

Unfortunately, no test is perfect and sometimes lesions are missed. And, about 1 in 1,000 surgeries involves a perforation of the colon, which leads to hospitalization and sometimes surgery.

You can increase your chances of getting the best colonoscopy in the following ways:

• Choose an experienced doctor. Don’t use your family doctor or an internist. Find a gastroenterologist who’s performed many colonoscopies. Ask him to explain the procedure to you, including how long he takes and how he ensures that he reaches the upper end of the colon. According to experts, it should take 6 or 7 minutes to withdraw the scope for a thorough inspection on the way out, which increases the likelihood of seeing the flat lesions that are the most often missed.

• Get an early morning appointment. Studies have shown that the early bird catches the cancer better. For every hour after 13, since the last dose of prep was taken, accuracy declines 10%. If you can’t be scheduled in the morning, splitting your prep between the night before and the day of the procedure will help.

In March of 2008, the American Cancer Society added the CT colonography (sometimes called the virtual colonoscopy) to its list of approved screening procedures. A CT scan of your colon reduces the risk of perforation and may seem more amenable to some people than having the scope inserted into the rectum. But you still need to do the prep work the day before, and if the doctor sees a polyp, you’ll have to have a colonoscopy to have it removed. Although it may be the only alternative for people with inflammatory bowel disease or obstructions, the CT colonography is not as accurate as a colonoscopy in detecting small polyps or flat lesions, and a negative CT colonography may not be equivalent to a negative colonoscopy. For most people, the colonoscopy is still the most comprehensive test.

The Anti-Aging Bottom Line: Colon cancer kills more than 50,000 people a year, but it’s actually 90% preventable, when caught in its early stages. Having regular colonoscopies after you turn 50 (or earlier, depending on your health history) could save your life. The procedure may not be the most comfortable experience you face, but it’s worth doing. The trade off could be facing a deadly cancer that might otherwise have been prevented.