TPR Lifeline: The Screening Test We Love To Hate

May 14, 2017

Colon cancer claims 50,000 American lives each year, second only to lung cancer.

The screening test called the colonoscopy is more invasive and time-consuming than some other cancer checks that only use x-ray or blood draws. Many people simply don’t get checked.

Bioscience-Medicine reporter Wendy Rigby talked to UT Health San Antonio gastroenterologist Randy Wright, MD, about ways to prevent this killer disease. 

Below is a transcript of the interview:

  

Rigby: This is the test people love to hate: the colonoscopy. Do your patients dread it?

Wright: The patients dread it. They just think that it’s a tough procedure to go through.

Rigby: Much of that is just people don’t like the prep.

Randy Wright, MD, sees patients at the University Health System's Robert B. Green campus in downtown San Antonio.
Credit Wendy Rigby / Texas Public Radio

Wright: When I ask people about the prep when they’re coming in for their colonoscopies I get a lot of yucky faces. But at the end of the procedure when I talk to them almost universally people say “I’m glad I had this. It wasn’t as bad as I thought it would be. I was comfortable the whole time. The prep was not the most pleasant experience in the world, but I got through it a lot easier than I thought that I would.”

Rigby: So this really is, in many ways, a preventable disease in that the test to screen for colon cancer can be used to literally find the problem and nip it in the bud, so to speak. Can you explain?

Wright: It is absolutely preventable. We have tests that can detect polyps, growths in the colon that sometimes can turn into colon cancer down the road. And the colonoscopy is a test that can remove those polyps and prevent colon cancer.

Rigby: So what is the technology that makes a colonoscopy possible?

Wright: We have remarkable fiber optic scopes, tubes with a camera on the end. They’re flexible. We can guide them through the rectum to the end of the colon and inspect the entire colon. And if we find polyps, which if we do find polyps in roughly 25% of people, we can find those polyps and remove them.

Rigby: And most insurances cover it?

Randy Wright, MD, specializes in gastroenterology and internal medicine.
Credit UT Health San Antonio

  

Wright: All insurances cover it. It’s mandated by the ACA that it’s covered as well.

Rigby: What is a virtual colonoscopy?

Wright: A virtual colonoscopy or you might hear the word CT colonography or CT colonoscopy is a procedure done with a CT scan in which a patient takes a prep, has a thin tube inserted in the rectum to inflate the colon with air, and then about a thirty second CT scan is done. A computer puts everything together so the radiologist or whoever’s reading the CT can see a virtual colon.

Rigby: But if they find a polyp, you would have to have a colonoscopy anyway to have it removed, correct?

Wright: That is correct. Depending on the size of the polyp, especially something greater than a centimeter, that person would need to go right away to have a colonoscopy.

Rigby: So who should consider which test and why?

Wright: There are some good uses for CT colonography. It’s one of the tests that the U.S. Preventative Task Force listed as appropriate for screening. For patients that are high risk for sedation or high risk for a colonoscopy, this would be a potential test for them.

Rigby: For your patients, though, do you suggest most of your patients go with the traditional colonoscopy?

Wright: I suggest patients go to a traditional colonoscopy where those polyps can be removed.

Rigby: Some people don’t talk to their physicians about this because it’s a difficult topic. But I’ve always had physicians who said “please don’t die of embarrassment and get the test.”

Wright: That’s absolutely true. You know, one thing I would really like to emphasize is the best screening test is the test that gets done. So for patients who are so uncomfortable getting a colonoscopy, there are other ways to screen for colon cancer.

Rigby: So if you’re over 50 and you’ve never had one, you should consider the test almost as a baseline, like women get baseline mammography?

Wright: That’s exactly right. And the main symptom of colon cancer is no symptoms. So that’s why it’s important to get screened once you turn 50.

Rigby: Dr. Randy Wright, UT Health San Antonio gastroenterologist, thanks for joining us.

Wright: Thank you very much for having me.

The weekly segment TPR Lifeline explores important medical issues with experts, and provides information that promotes healthy living.