Why Patients Avoid Colonoscopies—A Plea to Choose Wisely

Colon cancer, unlike so many other cancers, is a preventable disease.

Exercising good judgment can mean the difference between life and death. Life can be unforgiving of the choices we make. As we all know, many events are beyond our control and cannot be avoided. But there is much that we can do to shape our personal paths to brighter destinations.

Consider some of the choices listed below that many folks make every day. Are any of them familiar to you?

• Texting while driving.

• Riding a motorcycle without a helmet.

• Lifting an object that we know is too heavy for us.

• Driving a car when we have had one too many.

• Using our date of birth as our password for online bank accounts.

• Rushing through a yellow light so we won’t be late for a movie.

• Eating street food in a foreign country that appears undercooked.

• Getting chest pain for the first time after shoveling snow and deciding it was just heartburn.

Get the point?

All of the above activities can end tragically. But, they could also end up fine for us. We get many free passes in life. Every day, we confront forks in the road when we are offered a choice. Sometimes, we choose the wrong road. Sometimes, we make no choice at all. The point here is that we have a choice.

Some will choose risk and reward.

I see this issue in my gastroenterology practice. I’ve done at least 40,000 colonoscopies in my career, a volume so massive that I can barely believe it myself. Fortunately, the results of nearly all of them are normal or show benign findings. Telling a patient and their family that all is well after the procedure is a timeless pleasure.

But not every colonoscopy result is innocent. As you might imagine, I have confronted a fair amount of colon cancer in my career. When I discover one, I am aware that life for that person and his loved ones is about to change suddenly and profoundly. Life shifts in an instant.

While colon cancer affects the patient and his family most deeply, it’s a heavy day for the gastroenterologist too. We are human beings. What makes the day even darker for us is when the patient had faced an earlier fork in the road but made the wrong choice. Consider the following examples, which I have seen repeatedly in my practice.

• A patient declines to have a screening colonoscopy against the advice of his doctor.

• A patient has rectal bleeding and ignores it.

• A patient was told of hemorrhoids years ago. Rectal bleeding recurs and he assumes that the hemorrhoids are active again. He does not consult a physician.

• A patient’s bowel changes, but she decides that this must be a side-effect of new medication.

• A patient has a large colon polyp removed by his gastroenterologist. She is advised to return in a year for another colonoscopy, but does not do so. She is too busy.

Colon cancer, unlike so many other cancers, is a preventable disease. Modern medicine can't prevent every case of colon cancer. I am stating that the majority of cases I have discovered were in people who did not choose wisely when they should have. They ignored. They denied. They delayed.

Time after time, I have seen people who have had rectal bleeding for months or longer before they decided to see me.

Every expert will attest that the earlier colon cancer is diagnosed, the better the prognosis will be. But more importantly, a timely screening colonoscopy can prevent the disease altogether. We now begin colon cancer screening at age 45 instead of 50 in order to prevent more cases of this disease.

I haven’t made perfect choices at every fork in the road that I’ve faced. But when I reached the age of colon cancer screening, I did the right thing.

We can’t control everything. But there is much that we can control. For example, you have chosen to read this post. How you decide to use it is your choice.