Like father, like son: Two generations of GI doctors get cancer screening
As a gastroenterologist at the Mayo Clinic Health System in Red Wing, Dr. William David Farrar has helped patients for years to overcome the fear of having a colonoscopy, without having gone through the procedure himself. That changed last November.
Farrar's father, also a gastroenterologist, had a screening in October that found an early cancer. Now at a higher risk for colon cancer, Farrar would have to be screened almost a decade ahead of the recommended age of 50. At the suggestion of his wife, he wrote a journal documenting the experience.
March is National Colorectal Cancer Awareness Month, and Farrar said he hopes his journal will help ease patients' reluctance to get screened for the second leading cause of cancer death in the country.
"To be honest, I was looking forward to getting it done," Farrar wrote in his journal. "After performing colonoscopies on patients for almost ten years, I was somewhat intrigued to experience it from the other side."
Preparation for a colonoscopy is one of the most common reasons cited for why patients are hesitant to get screened for colon cancer, Farrar said. Especially for those who have gone through the procedure before.
The process leading up to a colonoscopy is first to empty the colon, often with a regimen of Gatorade mixed with laxatives starting the day before the screening. Patients can expect multiple trips to the restroom, and some will experience stomach cramps and nausea.
"But the prep really isn't that bad," Farrar said. "And we're trying to continuously improve the process." Patients are now allowed to eat a light breakfast and lunch the day before the screening to help control hunger, he said.
Before a colonoscopy begins, patients are often given sedatives or intravenous pain medication to make the procedure - which can last from 20 minutes to an hour - as painless as possible, according to the Mayo Clinic's website.
In Farrar's case, the sedatives turned the rest of his day into something of a blur.
"I remember voting," said Farrar, who had his colonoscopy on the morning of Election Day last November. "But I don't remember how I got there or how I got home."
Fear and risk
Along with the unpleasant preparation process, patients can also feel nervous or think that the procedure is "icky and wrong," Farrar said. "And that's understandable."
"But the fear is way overblown," said Farrar, noting that complications are rare.
Possible complications from a colonoscopy include reactions to sedatives, bleeding and a perforation or tear of the colon, according to the Mayo Clinic.
The risk of perforation from a colonoscopy is less than 2 percent, according to a study published in the Journal of the National Cancer Institute in 2003.
There also are a number of alternatives to colonoscopies, including a fecal occult blood test, or FOBT, and a less-invasive virtual colonoscopy that uses x-ray equipment to map the colon - but both screening methods have drawbacks.
FOBT screenings must be done every year - as opposed to every 10 years for colonoscopies - and virtual colonoscopies are still an emerging technology and not covered by all insurance companies, Farrar said.
"That's quite a good test, and I think it's going to be helpful for the future," said Farrar about virtual colonoscopies. "But it's not here yet."
One of the obstacles to finding colon cancer in its early stages is that the disease is often asymptomatic, Farrar said. "People don't have any symptoms, so they presume they're fine."
Farrar estimates that at least one third of people are not getting screened when they should.
Among the goals of colon cancer screening is to locate polyps, often benign growths that can develop into cancer, according to a National Cancer Institute colorectal cancer fact sheet. If found early, large or abnormal polyps can be removed before cancer can develop or spread.
Farrar's screening found one of those large polyps.
"All I could think was, 'Wow. I'm really glad I had this colonoscopy,'" wrote Farrar in his journal. "Looking at it more closely, it would be the type that would turn into cancer in the long run."
When found early, abnormal polyps can be removed using a colonoscopy.
"The whole reason why colonoscopies are effective is because we can see the precancerous states," Farrar said. "And you can remove them without surgery."
Even if the cancer spreads from a polyp to the colon wall or beyond, it is still fairly treatable, Farrar said.
Stage I colon cancer, which has just begun to spread into the colon wall, has a five-year survival rate of 74 percent, according to the American Cancer Society. At that stage chemotherapy and a partial colectomy may be used as treatment.
Farrar said the benefits of getting a colonoscopy and finding a precancerous polyp far outweigh the inconvenience and discomfort involved.
"It's a safe procedure and not a very big deal," said Farrar, now speaking from experience. "Just get it done."