By Dr. W. Gifford Jones
January 14, 2002
"Why in the name of Heaven do I submit to this procedure every five years? To be forced into such an undignified position makes me wonder each time if there's a God."
My answer remains conclusively the same. I'd rather face15 minutes of immodesty to months of dying slowly from cancer of the large bowel. So don't be fooled by a recent newspaper headline stating that colonoscopy isn't 100 percent foolproof. If you use this report as an excuse for not lying on the colonoscopy table it could be a fatal error.
The gold standard for diagnosing colon cancer has always been colonoscopy. But scientists with the Institute for Clinical Evaluative Sciences and the Universities of Toronto and Western Ontario recently reported a study showing that colonoscopy failed to diagnose cancer in 4 percent of cases. So what does this mean?
It emphasizes once again that there are only two things for sure in this life, death and taxes. Rockets costing millions designed by world class scientists sometimes blow up. It follows that procedures done by lesser mortals always have an element of error. Why does this happen in colonoscopy, and how can the batting average be improved? There are a few basic rules.
Rule # 1 Doctors cannot diagnose what they can't see. To diagnose colon polyps a video colonoscope is inserted into the large bowel. This sends a colour picture from inside the colon back to a TV screen. But to see polyps the bowel must be 100 per cent clean. If patients don't take laxatives followed by copious amounts of water, prior to the exam particles of fecal matter can hide polyps.
Rule # 2 Practice makes perfect whether you're designing rockets or performing colonoscopy. There are now more doctors available to do this procedure. But no doubt some missed polyps are due to doctors less skilled in this technique. Fewer polyps will be missed as they become more experienced.
Rule # 3 The more doctors look the more they see. If doctors try to rush through this procedure it increases the chance of error. So it's prudent to not keep asking the doctor "How much longer will it take?"
Rule # 4 Music reduces psychological and physiological stress. If more doctors played music during colonoscopy patients would be more relaxed and more polyps detected. A U.S. study showed that music decreased anxiety and heart rates and blood pressure did not increase. The benefits of music should not come as a surprise. Soldiers go into battle emboldened by music. It's also used in labour rooms to ease the pain of childbirth. It's believed that music increases blood levels of endorphins, a morphine-like substance. So relax and concentrate on the music.
There's no 100 percent way to prevent polyps but evidence shows that Aspirin, often labelled the wonder drug of the century, fights colon cancer. A large study by The American Cancer Society showed that Aspirin decreased the death rate from this malignancy by 40 percent. Aspirin may prevent the body from producing a chemical that causes intestinal cells to become malignant.
My advice to patients is to ask their doctor whether it's prudent to take a daily Aspirin. Particularly if they have a higher risk of developing colon cancer, such as a family history of this disease or if a colon polyp has been removed.
Some other studies show that ample amounts of calcium may decrease the risk of this malignancy. And milk is still the prime way to obtain adequate amounts of calcium.
Take a lesson from Uganda where colon cancer is rarely seen. Ugandans consume huge amounts of fiber resulting in soft stools that prevent constipation. Some researchers believe regular bowel movements stop cancer-causing substances from prolonged contact with the intestinal cells.
Remember that colon cancer does not develop overnight. It results from the growth of polyps. They're not rare. Studies show that over the age of 50 one in three people has developed a polyp, which if removed, prevents this disease.
So don't let fear, temporary discomfort or lack of dignity prevent you from having this procedure. And forget the 4 percent figure. Remember if a polyp is present and colonoscopy is not done the miss rate is 100 percent!
W. Gifford-Jones M.D is the pen name of Dr. Ken Walker graduate of Harvard. Dr. Walker's website is: Docgiff.com
My book, �90 + How I Got There� can be obtained by sending $19.95 to:
Giff Holdings, 525 Balliol St, Unit # 6,Toronto, Ontario, M4S 1E1
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