Tuesday, July 19, 2016

The 'No' in Colonoscopy

Be warned that this post concerns medical matters, and as such, should probably not be read over breakfast.

I went to the doctor yesterday to follow up on my recent gastrointestinal illness, which hit its peak while I was in Florida. The doctor seems satisfied with my conclusion that I had gastritis, and indeed nearly all of my unpleasant symptoms (stomach pain, bloating, gas, irregularity, cramps) disappeared after I began taking Nexium. So, in terms of the immediate, acute problem, I'm much better.

The doctor prescribed an additional medication for a "cleanse," to put it politely, which I may or may not do. It seems a bizarre recommendation, as my body now appears to be taking care of things in that department more or less normally.

Given my symptoms, though, I have an additional concern hovering at the periphery of my mind: colon cancer. This is a topic about which I have long been hyper-vigilant. My grandfather -- who I greatly resemble -- died suddenly from undiagnosed colon cancer at age 59. With that family history, I had two screening colonoscopies in the USA, and my doctor in New York recommended them every five years.

Next month, it will be seven years since my last colonoscopy. Last summer, I asked my NHS doctor in London about colon cancer screening, even with something as simple and inexpensive as a fecal occult blood test.

"Oh, we don't start that until you're 60," he said rather blithely. He told me to simply "keep an eye on things" and report back if I experienced anything worrisome. (Never mind that my grandfather had NO SYMPTOMS and was dead before he was 60!)

I've mentioned my concerns to two other doctors since. Yesterday, the doc confirmed that even with gastritis I am ineligible for cancer screening, given the absence of critical symptoms -- chronic diarrhea or bleeding.

So it seems that I have stumbled onto an area of medical disagreement between the USA and the UK. In the states, we're practically begged to get cancer screenings and colonoscopies. The American Cancer Society suggests that people of average risk begin them at age 50. That magic birthday comes for me this year. (Whether I am at average risk seems debatable -- my grandfather doesn't count as an immediate family member and apparently doesn't statistically elevate my risk, even if I do look like him and have his build. But my American doctor regarded that history as significant.)

Remember how Katie Couric, at age 43, had a colonoscopy on American national television to publicize the benefits of the procedure, after her 42-year-old husband died from colon cancer?

Well, here in the UK, the NHS says no. Katie Couric would have been turned away.

If I want a cancer screening, it looks like I need to pay for it myself -- probably a fecal occult blood test, since paying for a colonoscopy is out of my price range. (Granted, I'd have had to pay in the states, too -- except that I had private insurance there.) I understand the NHS wants to avoid unnecessary tests and expenses, but it's not reassuring to be told that I can't be screened unless I am bleeding, by which time early detection is a moot consideration.

(Photo: I walked home from the doctor's office along the Grand Union Canal.)


  1. Let me be the first to tell you how to live your life!! :-)

    An interesting post which points up differences between health care in Western countries. I'd be tempted to have this procedure when you next visit the US. However, you can do what you think best Steve.

    We have similiar things here in Oz where once you reach a Certain Age it seems it is no longer important whether you are screened for life threatening illnesses or not....

    And the photo - a barge loaded with garbage, one of your popular subjects. The garden photos were great yesterday; I can see why you stick out for a weed patch. Thistles and RAGWORT! Yes, I'm shouting. What are you thinking? Ragwort is a dirty word in this state, it came from Europe and spread like wildfire.

    I'll stop now.


  2. That IS a conundrum. Dang, boy. I don't know. You could lie and say you have chronic diarrhea. But I guess that would be wrong?

  3. Get the fecal occult test. That is affordable and you'll feel better knowing you've done it. The cleanse is a good idea too.

  4. Colon cancer is indeed a risk that should be monitored. Now the colonoscopy is another matter. I hate the prep for that test. I hope things do not deteriorate again.

  5. I've never had one and don't intend to get one. unless, of course I have bleeding or chronic diarrhea. the colonoscopy just seems like the procedure du jour. granted, if there was a history of colon cancer in my family I would probably have a different opinion.

  6. Wow, that is a bit of a dilemma. I think I'd do what "e" said and get the test. But, you might do some research on the accuracy of both tests and see what you think.

  7. colonoscopies are our faves! The "milk of amnesia" drug is lovely , like opium. Mr. Man has had a couple, Son, Erik has had a couple and I have had one. nothing found in any except more dollars in the pockets of the so called health care system. My brother had a couple as well...clean as a whistle, he died of colon cancer, it was not an inherited thing...so, nothing is perfect. The little swallowed cameras seem to be the most effective. You can do a 23 and ME genome work up, to find if you have a marker for it as well as markers for other inherited challenges. It is good to do anyway and affordable.

  8. Alphie: The problem with me having the procedure in the states is that I no longer have insurance in the USA; thus I'd be paying for it out of pocket. If I'm going to do that, I may as well have it here! The NHS isn't preventing me from having it, they're just saying they won't cover it. As for ragwort, if it's an exotic species in your area I can see how it might become a problem. Here it's native and, not only that, but a crucial part of the life cycle of the cinnabar moth. We love ragwort! :)

    Ms Moon: That's what Dave said! I might go that route.

    E: Yeah, I've ordered one. It only costs £25 and seems like a good place to start.

    Red: The prep isn't pleasant but the peace of mind is worth it!

    Ellen: If there's no history in your family and your digestive health is good, I suppose there's no reason to go there. Lucky you! :)

    Sharon: Well, accuracy is the issue. As I understand it the fecal occult blood test is not always accurate because it requires the presence of a bleeding lesion, and not all cancer actively bleeds all the time. But it's better than nothing.

    Linda Sue: I've never done that genetic thing. And I didn't know a swallowed camera was even an option! That sounds so sci-fi. I've never heard of anyone having a screening colonoscopy while healthy and STILL dying of colon cancer. Did much time elapse between the colonoscopy and the detection of your brother's illness? Yikes.

  9. I would start with the fecal occult blood test as well. I'm sure the doctors are following the prescribed protocol for making decisions, but I also think that medicine doesn't necessarily know everything there is to know. If you are very like your grandfather, that's probably not something that's ever been studied, and I would be cautious exactly like you're being. The thing about the fecal test is that it could give you a false negative but it cannot give you a false positive - ergo, if you get a positive result it would trigger the doctor to do a scope, wouldn't it?. For that reason alone I'd have it done. If you get a negative, you still have a decision to try to reach.

  10. P. S. I love your title, but wasn't expecting the doctor to be the one saying "no"!