Colonoscopy

Colonoscopy: The very word sends shudders down the spine of anyone who has drunk "the drink" -- the concoction that cleanses the colon so the doctor can later examine it. I've enjoyed three different procedures with three different preps, and I've made it my mantra to minimize the misery: The appointment: Just pick up the phone. The test is far better than cancer would be. My first one was early, at age 45, because my mother died of colon cancer. Feel nothing but gratitude that such a preventive procedure exists.

The Food and Drug Administration on Tuesday approved a new drug for cleansing the colon before colonoscopy exams that requires drinking only 10 ounces of the product, not the 2 liters required with some current products such as Go Lightly. The patient must drink other fluids as well, but that can be water, soda or other pleasant-tasting liquids. The new cleansing agent, called Prepopik, is expected to be marketed by October, according to the manufacturer, Ferring Pharmaceuticals Inc. of Parsippany, N.J. Colorectal cancer is the third-most common type of cancer in the United States and the second leading cause of cancer deaths.

The Food and Drug Administration on Tuesday approved a new drug for cleansing the colon before colonoscopy exams that requires drinking only 10 ounces of the product, not the 2 liters required with some current products such as Go Lightly. The patient must drink other fluids as well, but that can be water, soda or other pleasant-tasting liquids. The new cleansing agent, called Prepopik, is expected to be marketed by October, according to the manufacturer, Ferring Pharmaceuticals Inc. of Parsippany, N.J. Colorectal cancer is the third-most common type of cancer in the United States and the second leading cause of cancer deaths.

This post has been corrected. See note at the bottom for details. A colonoscopy is a life-saving procedure, identifying polyps and early-stage tumors so they can be removed before they grow and spread. But many people refuse to undergo the procedure because they don't relish having an endoscope inserted into their body, and they don't like the preparation for the procedure, which requires drinking laxatives and spending large amounts of time in the lavatory the night before.

Men and women may need different screening guidelines for colonoscopies because of varying tumor rates between the genders. A study released Tuesday in the Journal of the American Medical Assn. analyzed the results of 44,350 colonoscopy screenings over four years; the tests covered adenomas (benign tumors), advanced adenomas, and colorectal cancer. Generally, screenings are recommended for men and women starting at age age 50 because colorectal rates begin to climb in the following decade.

Colorectal cancer kills more Americans than any other cancer except lung cancer. But the death toll doesn't have to be as high as it is. Screening works. The American Cancer Society estimates that such tests saved 70,000 lives in the last 20 years. "Just think how many we could save if we did it right," says Dr. Otis Brawley, chief medical officer for the ACS in Atlanta. Doing it right would mean doing it on a lot more people. During those 20 years, only about 25% to 30% of the men and women who should have been screened — those age 50 or older — did get screened, Brawley says.

A swallowed capsule that takes pictures of the colon as it passes through misses too many precancerous lesions and is not ready to replace more traditional colonoscopies, Belgian researchers reported this week in the New England Journal of Medicine. The Given Imaging PillCam detects some tumors and polyps but missed five of the 19 tumors found in patients who were also checked with a colonoscopy, they said.

Re: "Cancer exams get political," April 18: The debate over virtual colonoscopy is emblematic of the dysfunctional way America makes healthcare decisions. Whenever a new, expensive procedure comes out, the question seems to be framed, "Should we pay for it?" It is very hard for me to believe that when available knowledge is taken into account and special interest groups have less influence, this procedure could not be performed with as good or better results at a fraction of the current cost.

President Reagan had two small polyps removed from his colon Friday during a routine follow-up examination intended to check for any recurrence of his 1985 colon cancer. Army Col. John Hutton, the President's physician, said that the polyps would be subjected to microscopic analysis, although they are "benign-appearing." Otherwise, Hutton said, nothing unusual was found during the examination. "The President continues to be in excellent health," he said.

This post has been corrected. See note at the bottom for details. A colonoscopy is a life-saving procedure, identifying polyps and early-stage tumors so they can be removed before they grow and spread. But many people refuse to undergo the procedure because they don't relish having an endoscope inserted into their body, and they don't like the preparation for the procedure, which requires drinking laxatives and spending large amounts of time in the lavatory the night before.

Men and women may need different screening guidelines for colonoscopies because of varying tumor rates between the genders. A study released Tuesday in the Journal of the American Medical Assn. analyzed the results of 44,350 colonoscopy screenings over four years; the tests covered adenomas (benign tumors), advanced adenomas, and colorectal cancer. Generally, screenings are recommended for men and women starting at age age 50 because colorectal rates begin to climb in the following decade.

The premise Joe (Ray Romano) and Manfro (Jon Manfrellotti) are good friends who go to a strip club the night before Manfro is scheduled to begin chemotherapy to treat Stage 3 colon cancer. Manfro, whose tumor had spread to his lymph nodes by the time it was detected in a colonoscopy screening exam, has already had surgery to remove the bulk of his tumor. At the club, he meets a stripper whose father also has Stage 3 colon cancer and went to the same oncologist that is treating Manfro.

Many patients receive repeat colonoscopies more quickly than are recommended by screening guidelines, increasing the risk that they will have rare, but significant, adverse outcomes from the tests, researchers reported this week. In a separate study, another group of researchers showed that many elderly who are sick or debilitated from other illnesses receive colonoscopies despite the fact that the procedures are probably not beneficial and may cause problems. Colonoscopies involve inserting a telescope-like instrument through the rectum to examine the interior of the small and large bowels so that doctors can look for polyps that are a precursor of colorectal cancer.

Colorectal cancer kills more Americans than any other cancer except lung cancer. But the death toll doesn't have to be as high as it is. Screening works. The American Cancer Society estimates that such tests saved 70,000 lives in the last 20 years. "Just think how many we could save if we did it right," says Dr. Otis Brawley, chief medical officer for the ACS in Atlanta. Doing it right would mean doing it on a lot more people. During those 20 years, only about 25% to 30% of the men and women who should have been screened — those age 50 or older — did get screened, Brawley says.

Colonoscopy is an important tool to detect colorectal cancer. In recent years, virtual colonoscopy, which involves a CT scan of the colon instead of the invasive, optical inspection of the colon, has been shown to be as effective as traditional colonoscopy. Now, a new study suggests that virtual colonoscopy may even be superior because it can identify cancers outside of the colon. In a study of 2,277 patients who underwent virtual colonoscopy, almost half were found to have some suspicious lesions outside the colon.

A swallowed capsule that takes pictures of the colon as it passes through misses too many precancerous lesions and is not ready to replace more traditional colonoscopies, Belgian researchers reported this week in the New England Journal of Medicine. The Given Imaging PillCam detects some tumors and polyps but missed five of the 19 tumors found in patients who were also checked with a colonoscopy, they said.

Trudy Lieberman's article "Matching Colon Tests to Patients, Not Costs" (March 19) left me reeling. Does she have an ax to grind or what? Her article was so one-sided, so vituperative against doctors and colonoscopy screenings that I could only wonder what huge personal insult had been committed against her. "Finding a competent, experienced doctor may be difficult." Really? Here in Los Angeles? Maybe in Upper West Slobovia. HOLLACE BROWN Los Angeles In trying to bolster her position that a colonoscopy is "a nasty affair," Lieberman says that a colonoscopy is "uncomfortable" and "requires sedation."

Virtual colonoscopy, a cancer-detecting procedure that gives doctors a computer-generated 3-D view of the colon, is less reliable than previously thought and not ready for widespread use, researchers said in a study in today's Journal of the American Medical Assn. Its accuracy varies considerably depending on the training and methods of the doctors performing it, according to a study of 600 patients at nine major clinics.

Re: "Cancer exams get political," April 18: The debate over virtual colonoscopy is emblematic of the dysfunctional way America makes healthcare decisions. Whenever a new, expensive procedure comes out, the question seems to be framed, "Should we pay for it?" It is very hard for me to believe that when available knowledge is taken into account and special interest groups have less influence, this procedure could not be performed with as good or better results at a fraction of the current cost.

Colonoscopy: The very word sends shudders down the spine of anyone who has drunk "the drink" -- the concoction that cleanses the colon so the doctor can later examine it. I've enjoyed three different procedures with three different preps, and I've made it my mantra to minimize the misery: The appointment: Just pick up the phone. The test is far better than cancer would be. My first one was early, at age 45, because my mother died of colon cancer. Feel nothing but gratitude that such a preventive procedure exists.