December 16th, 2008
03:07 PM ET

Colon cancer screening confusion

By Miriam Falco
CNN Medical Managing Editor

In a study published this week in the Annals of Internal Medicine, Canadian researchers found that colonoscopies, the procedure used by doctors to examine the colon for abnormalities and growths, is useful for finding cancer or pre-cancerous growths in the left side of the colon, but not so useful at finding them in the right side of the colon.

Now I’ve done a lot of stories on colon cancer and colonoscopies, but left and right sides of the colon haven’t come up that often.

Researchers think that colonoscopies may not detect as many cancers in the right, or “ascending” part of the colon because it’s the farthest region to reach with the probe, making it difficult to access.

But when I first read the study I wondered what people will think when they read the study results? Possibly that colonoscopies don’t work?

And the story headlines confirm my hunch:

“Colonoscopy Screenings May Not Be That Accurate”
“Colonoscopies Prevent Fewer Cancer Deaths Than Thought in Study”
“Colonoscopy saves lives, but study finds flaws”
“Colonoscopies miss many cancers, study finds”

It’s important to understand that colonoscopies are a screening tool, meant to detect the earliest signs of cancer. Having the screening at the recommended age of 50 can locate and remove pre-cancerous polyps, preventing the development of cancer. But, like other screening tools, the procedure isn’t perfect.

The accompanying editorial suggests doctors may mislead patients into thinking that the screening reduces the risk of colorectal cancer death by 90 percent, when it’s closer to 60 or 70 percent. The American Cancer Society told me that they conservatively say colonoscopies reduce the risk for colorectal cancer by about 50 percent.

I spoke with Dr. Hal Sox, editor of the journal, to get clarity on the message they are trying to send. Sox said the message is not to discourage people from getting a colonoscopy, but to stress that it’s not a perfect screening tool. A clean colonoscopy doesn’t mean that people who have other symptoms, such as blood in the stool, shouldn’t have themselves checked by a doctor.

Colorectal cancer is the third most commonly diagnosed cancer and the third-leading cause of cancer death in both men and women in the United States. Getting screened and finding polyps or tumors early saves lives.

Have you had a colonoscopy? If not, why?

Editor's Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.

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soundoff (48 Responses)
  1. HM

    Two years ago I had my first and only colonoscopy.

    I refused any medication during the colonoscopy, and instead watched the process on the screen along with the doctor and nurses who were watching also.

    Of course, there was the left side, transverse, and right side exams. The doctor even showed me (in high resolution) my appendectomy scars from forty five years ago, from the -inside- of the right side of the intestine.

    An article saying that the right side might not be examined as well as the left, just makes no sense to me.

    December 16, 2008 at 20:36 | Report abuse | Reply
  2. mk

    Colon cancers are more often missed in the right colon bcause they demonstrate a different biology and propensity than polyps and cancers in the rest of the colon: they tend to develop from smaller, flatter polyps, sometimes "depresssed" in shape:and may become cancerous more rapidly due to their specific genetic defects. In addition, polyps and hence cancers on the right side may be missed not because it's farther along the organ but because bowel preparation is often incomplete on the rigt side and small areas of retained stool may obscure small lesions. Still, screening for colon cancer is effective at reducing the incidence of colon cancer and in finding cancers at earlier and more curable stages. No screening for any cancer is perfect, including mammography, Pap smear and chest xray – but some degree of protection is far better than none.

    December 17, 2008 at 14:37 | Report abuse | Reply
  3. LynnAnn

    I'm 58, and I know I need one, even think I might have symptoms of colon irritation....my reason for not having one is the expense. it's more than $3500 here where I live.

    I have catastrophic health coverage only and would have to pay the whole amount myself..which is impossible!!! I like the idea of socialized medicine...then I'd have the test...

    December 17, 2008 at 15:58 | Report abuse | Reply
  4. SB

    LynnAnn, you only need screening colonoscopy once every 10 years! Besides, the cost of routine screening colonoscopy should be around $1000. If you are paying three times as much it's because you're also paying for 2 non-paying patients (or maybe for their emergency room visits). Many facilities will give significant discounts when you pay up front.
    Be careful wishing for a socialized medicine.

    December 17, 2008 at 19:56 | Report abuse | Reply
  5. sa

    My husband and I are both late 50's. I had a colonoscopy at 55 under the agreement that my husband would have his too. We have health insurance that pays the entire cost. He didn't go through with his. Why? I believe a combination fear of needles (pre-screening plus anesthesia the day of) and fear they might actually 'find something.' He does have a family history for colon cancer. There lies the rub. I haven't had a mammogram in years because I do have a family history and I'm fearful what they might actually find. I can never seem to find the right time. either it's the Holidays and I don't want any 'rude surprises' or we're going on vacation, or it's busy at work....

    December 18, 2008 at 10:19 | Report abuse | Reply
  6. IN

    I go for coloscopies every three years since I turned 16. I have a huge family history of colon cancer (FAP to be exact) and dying. There is nothing to them, I am sedated and they can remove my polyps (if any) at the same time.

    December 18, 2008 at 14:26 | Report abuse | Reply
  7. cdb

    I reviewed the study and am not at all surprised that only 31% of the colonoscopies were performed by gastroenterologists. 40% were carried out by general surgeons and the remainder by general internists and primary care providers. The training requirements for endoscopy for a gastroenterologist are far more rigorous than for a non-GI specialist. It is a well known statistic that the likelihood of missing a potentially important right colon lesion decreases as the experience of the endoscopist increases, likewise for complication rates. A gastroenterologist will typically perform several thousand per year vs 50-100 for a primary care physician or several hundred for a surgeon. This is a real problem in the United States as there is little regulation on who can perform this procedure. I imagine it is worse with socialized medicine as there simply are not enough specialists to meet the demand. When having a colonoscopy you should ask three questions of the endoscopist: how many do you perform per year, what is your rate of intubation into the terminal ileum and what is your minimum withdrawal time. If he/she is not able to give a quick and confident answer, go elsewhere. Or better yet, have a gastroenterologist perform the procedure. Also, you may be surprised to find that the gastroenterologist's fee may be less. There will always be cases where a precancerous lesion is missed but it is much less likely in capable hands.

    December 18, 2008 at 22:14 | Report abuse | Reply
  8. L.J. DiGiusto

    Last year I had a colonoscopy and it discovered a polyp on the right side that could not be removed by colonoscopy but by surgery... the surgery was successful. I was very lucky. The polyp was benign.
    I would recommend that everyone 50+ have a colonoscopy done. It's a very smart play.

    December 21, 2008 at 18:36 | Report abuse | Reply
  9. Jo Ellen Navarro

    My husband had his first colonoscopy 2 years ago by a gastroenterologist. There were 4 polyps removed and one too large to be removed. He had surgery for that polyp in his rectum which was malignant. The surgeon then scheduled him for a coloscopy (without explaining what it really was to us). He had the surgery and sees an oncologist every 3 months for lab work. They say he is fine and no sign of reoccurence; however, in this time, my brother has died from kidney cancer, our son has died from testacular cancer (metastisezed to the liver) and our best friend has died from colon cancer. Yes, we are always afraid but it has been 2 years now and he is alive, but he is miserable and Hates the colostomy bags. He says he would never go through it again. I recommend the colonoscopy and endoscopy (as I have Barrets) but, PLEASE ask lots of questions....

    December 27, 2008 at 16:55 | Report abuse | Reply
  10. Gupta Gastro

    We take colon cancer screening very seriously. The death toll from colorectal cancer is much higher than it needs to be. The rates of death are so high that it is almost equivalent to the American deaths during the Vietnam war YEAR after YEAR. Do your research. Make sure you are going to a Gastroenterologist that is qualified and experienced in endoscopic procedures. Cancerous polyps are sometimes found in individuals who are younger than the recommended screening ages. These screening ages are general guidelines that are adjusted constantly. If you are unsure if you should get tested, please inquire with a Gastroenterologist. They are usually the most up-to-date with screening guidelines. If you are in Brooklyn or Queens, NY, you may check out http://www.guptagastro.com or call (718) 372-7434

    February 18, 2009 at 18:52 | Report abuse | Reply
  11. Lynn Cramer

    I lost my father to colon cancer in 1997. Then my mom had uterine cancer in 2002, she is now cancer free. I had some blood in my stool which scared me a bit. I had three seperate doctors tell me that I NEEDED to get a colonoscopy ASAP. I went to the facility and setup the appointment. Came in on the day scheduled and found that I had no polyps, just hemorroids. Thank God! I get the statement from the Mountain States (our "wonderful" insurance administrator) and it says: $1500 not covered for the facility and $818 not covered for the doctor. I was only 43 when it was done and it is considered a routine screening. After about 12 phone calls I found the facility had coded the procedure using the family history code first. I got them to resubmit the claim using the anal bleeding as the first code. I was told by the Mountain States people that the bleeding would make it a nonroutine procedure which would probably be covered. Still no word on payment. I can't believe three doctors almost demand I have this procedure and insurance doesn't want to pay. I guess I should have waited until I was 50 with a colon full of malignant polyps!!!!

    March 5, 2009 at 21:18 | Report abuse | Reply
  12. Genesis Alexander

    Colon cancer can be avoided if you just keep high fiber foods in your diet.`;~

    July 9, 2010 at 12:20 | Report abuse | Reply
  13. Camila Perry

    the former president of the philippines Corazon Aquino died also of colon cancer..:

    July 12, 2010 at 12:28 | Report abuse | Reply
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Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love.