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Why You Need a Colonoscopy At 50 or Younger — And What to Expect

They found a number of pre-cancerous polyps during your father’s colonoscopy. You will need to have your first one at 40-years-old as a precaution. 

I was only 30 at the time I received the text from my mother. What the heck is a polyp? and What does this mean for my father? were my first thoughts. I was in the midst of raising young kids while working on my career and polyps and colonoscopies were far from on my radar. But this unexpected text from my mother provided me with a crash-course in colorectal health. 

I learned that my father was diagnosed with pre-cancerous polyps, small clumps of cells that if left undetected could develop into colon cancer, which put me at an increased risk for colon cancer. The doctor removed the polyps and my dad would continue to have regular screenings. 

Once I learned that my dad was going to be okay and he was lucky to have caught them before they progressed into full-blown cancer, I put the thought far out of my mind. Forty was a decade away and I just didn’t have time to worry about something as unsettling as a colonoscopy. I will cross that bridge when I get to it, I thought. 

Well, guess what? I got to it and I haven’t done it. I am now pushing 42 and my colon remains completely unscreened. I am really uncomfortable with the thought of a colonoscopy and it is easy to say no thanks. I have no concerning symptoms and I feel pretty darn healthy. So, why sign up for such an invasive procedure? 

But rather than shy away from the topic in avoidance, I decided to get the answers I needed to prepare for the procedure that I know I must schedule. I spoke with Tarek Hassanein, MD, who is board-certified in Internal Medicine, Gastroenterology and Transplant Hepatology to get to the bottom (pun-intended) of it all. 

Do I Really Need to Get a Colonoscopy?

Everyone, at one point or another should get a colonoscopy. The current medical standard suggests that men and women should receive a routine colonoscopy at the age of 50. “There is a debate about decreasing the age of screening below 50,” says Dr. Hassanein. “However, any individual with a family history of colon cancer should get a colonoscopy 10 years before the initial case was diagnosed.” If testing finds a healthy colon with no polyps or cause for concern, you likely will not need another for 10 years. 

Why are They so Important? 

Statistics alone speak for the importance of the test. “Recent data shows colorectal cancer is the third most common cancer in the US, representing 8 percent of all cancers,” says Dr. Hassanein. “Colonoscopy is accurate in detecting cancer and polyps more than 90 percent of the time and is still the most reliable tool to detect colon cancer. Removal of polyps decreases the chances of progression to cancer.” 

Colon cancer affects men and women equally, is the third most commonly diagnosed cancer, and the second leading cause of cancer death, according to the Colon Cancer Coalition. It is not simply more common that other concerns, it is actually more deadly if not found in the early stages. Early diagnosis is key, and while the procedure may not be the most comfortable, it has, for many (like my father) been life-saving. 

What Can I Expect? 

The preparation is likely the worst part of the procedure. You will receive instructions from your healthcare professional prior to your appointment. Read them closely at least a week before your scheduled appointment. It is best to take at least two days off from work, one for the preparation, and one for the day of the procedure. 

Preparation typically includes eating only white foods for a few days, followed by a liquid-only diet for 24 hours prior to the procedure. You will be provided a liquid laxative to help clean the colon, so make sure you are near a bathroom for this part of the process. It is important to clean the colon, so your doctor can see the inside clearly and get pictures during the colonoscopy. The procedure itself takes about 30 minutes and is usually performed while the patient is sedated, so you will need to line up a driver to accompany you. Most people are back to normal as soon as the sedation wears off and able to return to work the following day. 

What Happens if They Find Something Concerning During the Procedure? 

If your doctor finds any abnormalities like a polyp or inflamed tissue, it is possible they will remove it right then and there. Sometimes, there may be a need to biopsy it and send it to the pathologist to understand its nature and plan further intervention, says Dr. Hassanein. Remember that you are in the hands of a trained specialist; try to trust your medical provider. Once you wake from the procedure, a doctor or nurse will discuss the results and what further treatment (if any) is needed. Hopefully, you will wake to the news that you have an entire decade colonoscopy-free! 

Can I Use the Mail-in Tests

In recent years, mail-in kits like this one from Colorguard, have become available as an alternate to colonoscopies. They require patients to send in a stool sample via mail, from which the company will conduct a DNA test to detect cancer and pre-cancer cells. This is a much-less invasive procedure, but Dr. Hassanein warns against using this as your only screening method. “Testing of stool is becoming part of the workup to find colon cancer, but this is not to replace colonoscopy,he says. If you are interested in using an at-home test as your first step to colon screening, be sure to talk to your healthcare provider to determine if this is option is right for you. 

I can think of 187 things I would rather do with two days off than get a colonoscopy, but imagine if my father had delayed his test? He might not be with us today. The best thing to do in the face of trepidation is to stop over-thinking and make that appointment. So colonoscopy, here I come…ready or not. 

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