Colon cancer kills approximately 50,000 Americans each year. And screenings save lives. But having a colonoscopy is not without risk. About three out of every 1,000 people who have the procedure experience serious complications, such as bleeding and perforation. The chances of having a problem depend in part on where the procedure is done and the type of anesthesia used. This is what you need to know.
When do you need to get screened?
Experts say that most people should have their first colonoscopy at age 50. If no precancerous polyps or cancer are found, you can usually wait 10 years for the next one. But many doctors tell even low-risk patients to come back sooner. The guidelines also indicate that most people can stop being screened at age 75, since after that age, the risks of the test begin to outweigh its benefits. But a 2013 study found that roughly two-thirds of people older than that age had unnecessary colonoscopies. So if your doctor tells you that you need a colonoscopy more than once every 10 years or after age 75, ask why.
Instead of a colonoscopy
There are less invasive screening options than colonoscopy, including a DNA test known as Cologuard that was approved by the Food and Drug Administration (FDA) last summer. This requires you to take a stool sample at home and send it to a lab for testing and may need to be repeated every three years. Options with follow-up records include an annual blood stool test and a sigmoidoscopy (which examines only the lower third of your colon) every five years plus a stool test every three years. If the results of any of those tests are worrisome, you'll need to have a colonoscopy to confirm the results.
Learn about anesthesia
Many people think that they need to be completely put to sleep during the procedure. But this can be done without anesthesia or with conscious sedation, in which a medication like midazolam is used to relieve pain while allowing you to be alert. "You want to aim for the lowest level of sedation you need," says Orly Avitzur, M.D., Consumer Reports medical consultant. "The trend towards deep sedation is concerning as it increases risk."
Find the right clinic
Most colonoscopies are not performed in hospitals, but rather in ambulatory surgery centers. That's okay, research suggests they're just as safe as hospitals for the procedure. But not all centers are the same. Look for one that is certified by Medicare and ask how many of the clinic's colonoscopy patients have had to be hospitalized due to infections. “The correct answer is zero,” says Lisa McGiffert of Consumer Reports' Safe Patient project. Going to a hospital may be safer if you've had a recent heart attack or have lung disease or another risk factor.
check your bill
The Affordable Care Act requires insurance for colonoscopy. But ask your insurance company if you'll have to pay for the prep kit or part of the pathology, facility, and anesthesiology fees. Check your bill afterwards too. Diagnostic colonoscopies to investigate symptoms like stomach problems or anemia don't have to be fully covered, so doctors may code your procedure into that category, leaving you with a big bill.
The best way to prepare
You are limited to a clear liquid diet for approximately 24 hours prior to the procedure and may need to drink up to a gallon of laxative solution. To improve the flavor, chill it first or ask your doctor if it's okay to add lemon, lime, ginger, or a flavor enhancer like Crystal Light. Other steps that may help include eating lighter than usual, including less fiber, for a few days before your preparation; use a straw to drink the solution; stay near a bathroom and use flushable wipes and diaper ointment to soothe irritation.
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