You Probably Don’t Need A Colonoscopy

Quite often the patient sitting before me helpfully finishes my sentence. “Yeah, yeah, I know, I need a colonoscopy.” This happens in person or during a Telemed visit when I remark how they’re approaching (or recently turned) 50, 60, or beyond.

Or they’re a few years beyond 50 or 60, and I genially ask, “Your colonoscopy current?”

I do not willfully induce the stricken look or the dead silence on the phone. In fact, I try to look, or at least sound, empathic.

Since nobody wants a colonoscopy, the two most common patient responses I hear when a colonoscopy is due are perfectly reasonable. It’s either “I’ve been meaning to get one” or “I had one once. The prep was so horrible I just keep putting off the next one.”

And so I enjoy the delighted smile or the surprised “Really?!” when I say they likely won’t need a colonoscopy, either as a first timer or as a repeater.

People at higher risk
In fact, the only people who really need a full colonoscopy are those with a higher- than-average risk for developing colon cancer.

You’re among this group if you have a:

–Significant family history of colon cancer, meaning you have a first-degree relative (parent, sibling, child) who had colon cancer.
–Previous abnormal colonoscopy (showing one or more intestinal polyps or inflammation).
–History of certain illnesses, including ulcerative colitis or Crohn’s disease.
–Genetic predisposition to developing cancer anywhere in the body (fortunately, this is rare).

Otherwise, you’re a candidate for a test called Cologuard. Many people have never heard of Cologuard, though the company advertises regularly on TV and in magazines. I suspect even if people saw the ad they’d ignore it, thinking if Cologuard were all that good their primary care doctor would have told them about it.

To be honest, doctors are slow to embrace new ideas, especially one as radical as discouraging colonoscopy in an average-risk patient.

Moreover, if a primary care doc were to ask the local gastroenterologist what he thought about Cologuard, he’d likely not hear the truth, which would be “It’s very reliable and I see it as a major threat to my income stream.”

Believe me when I say the major medical centers, like Northwestern and Rush, with dozens of gastroenterologists on the payroll, are not going feature Cologuard brochures in the lobby.

How easy is the Cologuard test?
If you don’t have any of the risks listed above, answer this one question.

“Can you move your bowels?”

If you answered yes, you’re a candidate for Cologuard.

Or, to make it a little more challenging, “Can you collect a small amount of fecal material in a special container, add a liquid preservative, screw the lid on tightly, and mail it back to the lab?”

There’s no special prep, no change in your diet, no missed workdays. You don’t even have to wear a hospital gown that opens in the rear.

Your physician can prescribe a Cologuard or you can contact Cologuard directly and they’ll supply a telemedicine provider (MD or nurse practitioner) to OK it.

Cologuard will then contact your insurer for approval, though virtually all insurers cover the test.

The Cologuard collection kit will then be mailed to you. If you need help with it, here’s a link.

Is it accurate?
Cologuard is as accurate as a colonoscopy for average-risk patients. It works by using DNA technology. Any abnormal growth (polyp, cancer) sheds cells containing abnormal DNA. If any are found, that’s a situation that requires further investigation.

And that “further investigation” will, of course, be a colonoscopy.

Among the couple of hundred Cologuards I have ordered, fewer than ten results were positive and all of them turned out to be due to small polyps that were removed during the follow-up colonoscopy.

Speaking of colonoscopies, I refer all my positive patients to Lotsu Digestive over in Greektown.

There are four reasons for this, the most important being that Dr. Lotsu is an excellent gastroenterologist who spends a lot of time discussing the procedure beforehand and his findings afterward.

Second, Lotsu Digestive is a small office, and the procedure is performed on-site. You don’t need to travel to a large hospital where colonoscopies are performed assembly-line style.

Third, since you’ll need to fast before a colonoscopy, you’ll be famished when it’s over and you can reward yourself with a nice Greek meal. Opa!

Lastly, Dr. Lotsu is my wife’s gastroenterologist and she told me I’d be crazy to send a patient to anyone else.

He’s not, however, my gastroenterologist. I use Cologuard.

Be well,
David Edelberg, MD