INTIMATE NOTES ABOUT MY FORTHCOMING COLONOSCOPY

By Richard Altschuler

While reasoning out why I’m getting a colonoscopy next week, I found myself thinking about the odds of getting hit by a bolt of lightning - and how I and most everyone else react to that possibility. Only a few people ever get hit by those “bolts from the blue,” of course, but most everyone tries to avoid them, by staying indoors. Why? Because though the odds a given person will be hit are almost zero, the consequences of that outcome are so grave almost no one seems to care about the odds of getting hit - only the possibility that it could happen to oneself.

That brings me to my impending colonoscopy. In deciding to go ahead with the “procedure,” I’m totally choosing to ignore the logic of statistical probability - since the overall rate of death from colon cancer is 21 per 100,000 population (age-adjusted to the year 2000 standard population) - or about a .00021 probability of occurrence. The colon cancer death rate is even lower for people with my background and history - since I’m in very good health and “middle age,” have no unusual bowel/excretory symptoms or family history of colon cancer, and am Caucasian and highly educated - all factors that reduce the probability of colon cancer for specific segments of the population.

Despite the teeny probability of any person dying from colon cancer in a given year, the overall statistics about the “rectal terminator” make one take notice:
> Colorectal cancer is the second leading cancer killer in the United States, and the third most common cancer overall.
> In 2002, more than 50,000 Americans will die from colorectal cancer and approximately 131,600 new cases will be diagnosed.
> Eighty to 90 million Americans (approximately 25 percent of the U.S. population) are considered at risk because of age or other factors.
> More women over the age of 75 die from colorectal cancer than from breast cancer.
> The American Cancer Society estimates that about 107,300 new cases of colon cancer (50,000 men and 57,300 women) - and 41,000 new cases of rectal cancer, including 22,600 men and 18,400 women - will be diagnosed in 2002.
> The cumulative lifetime risk for the disease is 1 in 20.

Okay, I think to myself, “statistics, schmastics.”  What’s that got to do with the miniscule probability of me having colon cancer or polyps right now? Nothing, really, from a statistical point of view.  But what would happen, I think, if I did have polyps, or even the undetected  “big C” right now?

To safeguard against that possibly horrific occurrence, I am agreeing to get myself “scoped” next week - as my physician so casually referred to the video invasion of my rectal canal while reviewing the benefits and risks of the exam in his office the other day.

The “benefits” are . . . now let me see: If he finds a polyp or polyps in my colon, he can snip them out; and that should prevent cancer from growing in my colon, since the cancer is “caused,” he said, by the polyps, which appear first. Hmmm.  Okay, let’s say I buy that.  Of course, he could find cancer already there, and recommend treatment right away, which could save my life.  Virtually no chance of him finding that, I’d bet, given both how I feel now and my family and personal history.

In the doctor’s office, during the consultation, thoughts of Katie Couric getting a colonoscopy on national television, during her “Today” show on NBC, danced through my head.  What a weird thing for her to have done, I thought. What a special person she is to have done that. And thoughts of why she did it came to my mind . . . her husband, Jay, who could have been saved, she insists, if only he had had the exam.

George W also comes to mind.  Having had a colonoscopy a few weeks ago, he impressed upon everyone that it’s considered very important - or why else would the President of the United States have done it?

The “benefits” list is oh so short, but possibly oh so important (if the almost impossible comes to pass) - since the 5-year relative survival rate is 90% for people whose colorectal cancer is treated in an early stage, before it has spread. Once the cancer has spread to nearby organs or lymph nodes, the 5-year relative survival rate goes down to 65%. Hmmm.  More statistics. . . . more food for thought.

And now for the risks. “Can I die from a colonoscopy?” I asked the doctor.  Yes, he said, but the risk is “extremely small.” How can I die? From a perforation or puncture of the colon that is not treated soon enough.  How often does a puncture happen? Somewhere between about one in every 2,000 exams or 2 in every 1,000 exams (depending on the article you read).  When that life-threatening outcome does happen, however, it is almost never from just a “look-see,” the doctor said, but, rather, from removal of polyps.  In the event of a punctured colon, surgery is usually required to repair it.

Any other risks?  Bleeding can occur from polyp removal, which can cause pain and, much worse, infection.  Sometimes there are adverse reactions to the narcotic that patients are given to enable them to withstand the pain (and humiliation?) inherent in the “procedure.”  And, oh yes, in very rare instances, someone dies from cardiac arrest during the procedure.

While discussing the risks with me, my doctor said, “I’ve performed over 7,000 colonoscopies in nine years, and have never had a problem.”  I found that reassuring to hear, of course, as I thought, “Wow, what a goldmine this guy has!”  That’s nearly 20 “scopes” a week, on average, and business is sure to go up as both more celebrities flaunt their colons before the national media and an increasing number of people die every year from colon cancer, as our population continues to increasingly grow older.

“Are there alternatives to colonoscopy?” I asked.  He mentioned a few that were less effective, including a barium enema x-ray of the bowel. It will give similar information although it is not as accurate for certain problems and it does not allow biopsies or removal of polyps. It also does not require sedation or hospital admission. Hmmm, I thought about that.

Weighing all the factors - the odds that I have a problem in the first place, and considering the benefits and risks of colonoscopy - I ask myself, “Does it make sense for me to get  it? Am I doing the wise thing, or have I been ‘sold’ on a procedure by the medical-marketing establishment?”

 After careful consideration of these important questions, I arrive at a definitive answer about the wisdom of my having a colonoscopy: “I DON’T KNOW!”

But that answer, of course, has nothing to do with what I will do.  I will have the procedure!  In fact, as fate would have it, while I was writing this piece, my phone rang, and it was my doctor’s assistant. She wanted to know if I was confirming my colonoscopy for August 8^th.  I found myself saying “yes” on the phone - even as I was trying to reason out what wisdom should dictate. So I can see by my answer to her that I am in the grip of a certain “force of medical authority,” which I feel compelled to obey.

Of course, if I did not have medical insurance that would cover the procedure, I wouldn’t even think of getting scoped, unless I had some serious symptoms.  So in a way, I feel I am at least “getting my money’s worth” from the insurance policy I’ve already shelled out tens of thousands for over the years, even if nothing else about my decision makes much sense to me.

As I watch the clock tick over the next week, I’ll be thinking about what makes me “tick”- and also about Katie Couric, George W, morbidity and mortality statistics, the medical establishment, and the odds of my getting hit by a lightning bolt as I’m walking to the subway.