The Future of Colonoscopy

Doctors use a snare to remove a precancerous polyp from the inside of a patient's colon.
Doctors use a snare to remove a precancerous polyp from the inside of a patient's colon.
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CUDA: Getting a colonoscopy is hands down the best way to prevent colon cancer, but it’s never much fun – just ask Veodis Byrd. He’s preparing for his latest colonoscopy –one of dozens he's had throughout his lifetime because of his higher risk for the disease. The unpleasantness starts the night before when he has to drink a salty laxative to clear out his digestive tract.

Filling glass, drinking

BYRD: Gotta do the whole jug and that’s a lot of eight ounce glasses……….

CUDA: 17 over the next 2 hours to be exact. That's nearly the equivalent of two two-liter bottles of soda -- all so that tomorrow morning his doctor can look inside his colon with a camera and get a clear view.

VEODIS :Ok most people think that, you know, somebody is going up their rear end it’s kind of degrading but if you look at the reasons why it’s being done it’s well worth the time to do it.

CUDA: And Byrd has his reasons – he's already had a number of pre-cancerous growths called polyps removed from his colon. Just the idea of a colonoscopy makes most people squirm, but Byrd he says its not that bad – If only everyone were so proactive, the disease would claim far fewer lives, explains Sanford Markowitz, a colon cancer researcher at Case Western Reserve University.

MARKOWITZ: 150,000 people are going to get colon cancer this year and 50, 000 are going to die from it. So we have colon cancer killing more people than breast cancer, we have colon cancer killing more people than prostate cancer. And yet nobody should die from colon cancer because colon cancer is the disease where it's clear, par excellence, that if you catch the disease early, the surgeon can cure it.

CUDA: If everyone had a colonoscopy starting at age 50, fewer than 1 person out of 10 would die. It's that simple. But only about half of Americans over age 50 have ever had even a single colonoscopy.

CHURCH: It's very frustrating for me when I see patients coming in with colon cancer knowing that that could have been prevented if they had had a colonoscopy.

CUDA: Dr. James Church of the Cleveland Clinic is performing Veodis Byrd's colonoscopy –

CHURCH: ….and here comes the scope

CUDA: As the scope winds through Byrd's colon, he points out the polyps he finds.

CHURCH: this is a typical little polyp right here.

CUDA: All colon cancers start off as something called a polyp – a small mushroom-shaped mass of tissue that grows out from the lining of the colon wall. When Dr. Church finds one, he uses a little wire loop that’s attached to the camera inside to snip it off. By removing these growths early – Church is nipping the problem in the bud-as it were- the polyps never get the chance to become cancer.

But Dr. Markowitz says that for too many patients it's simply not an option they are willing to consider or their insurance won’t pay for it. So even though a colonoscopy is the gold standard for detecting colon cancer, they are looking for screening tests that are less invasive, less expensive, and more patient-friendly. One method is something called a virtual colonoscopy. It's basically a CAT scan of the colon. But insurance generally won't pay for it, and if the doctors do find something, a traditional colonoscopy is still needed.

Sanford Markowitz and his team at Case are developing new screening tests that detect the DNA of cancer cells in a person's stool or blood. He says it can detect anywhere from half to 3 quarters of colon cancers. That's less accurate than a colonoscopy, but it's on par with other well known cancer screening tests like mammography.

MARKOWITZ: So we understand that when we do mammograms that about 20-25 percent of the time an abnormal mammogram will turn out to be an early cancer. In the case of these stool DNA tests, it's about the same.

CUDA: The DNA stool test has been endorsed by the American Cancer society as an alternative to colonoscopy -- Still critics – and even Markowitz himself –say it’s not a substitute for colonoscopies but rather an alternative for patients who would not be screened otherwise, used in between regular colonoscopies, or after surgery to ensure the cancer hasn't come back.

MARKOWITZ: I'm not here to dissuade anyone from having a colonoscopy - and in fact, give me a megaphone and I'll scream it "have your colonoscopy!" But we also have to recognize that we need something that's an alternative.

Gretchen Cuda, 90.3


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