The most expensive test you may not need

Your doctor probably encourages you to get regular colonoscopies once you hit 50 years. Doctors order these tests to screen for cancer or polyps growing on the mucosal surface of your colon.

And to be sure, some people have genetic risk factors that increase their chances of developing multiple polyps and colon cancer. And we should follow these cases closely. But for everyone else, are these tests really worth it? Especially once you do hit a certain age?

Truly, anyone can potentially develop a colon polyp. And there is a chance that such a polyp can harbor colon cancer. But it takes 15 years on average for a benign polyp to develop into colon cancer.

So, if you get a colonoscopy at age 65, you probably don’t need another one until you’re 80. Unless you have a genetic risk factor. In light of this 15-year lag time, how old is “too old” to go through this procedure if you don’t have a genetic risk?

Here’s something else to think about the next time your doctor orders a “routine” colonoscopy. They’re not as safe as you might think. Sure–some celebrities and doctors like to portray colonoscopies as benign and safe.

But this couldn’t be further from the truth.

In my forensic medicine practice, I have seen case after case of fatal complications following “routine” colonoscopies. Patients died of perforated intestines. They died of inflammation to the abdominal cavity (peritonitis). They even died of lacerated and punctured livers along with massive bleeding.

I remember another case where the doctor pumped air into a patient’s colon to inflate it for easy examination. But the air perforated the intestine and escaped into the patient’s abdominal cavity. This put so much pressure on the liver, it cut off blood supply back to the heart. We ultimately figured out that the patient died from shock!

Of course, colonoscopy has become a very lucrative business. In fact, according to a recent New York Times article, colonoscopy is the sole reason why the U.S. leads the world in health expenditures!

In the U.S., most colonoscopies cost about $1,200. But many doctors get away with charging up to $20,000 for this outpatient procedure that requires less than one-hour of their time. In many other developed countries, a colonoscopy costs just a few hundred dollars.

It is not just colonoscopies that are too expensive in this country. Hospital stays are three times more expensive here. (Even though insurance companies keep cutting our stays shorter and shorter.) Hip replacements cost four times more here than they do in Europe. Caesarian sections are three times more expensive here than in Britain or New Zealand. Even a common nasal spray for allergies cost five times more in the U.S. than in Europe.

But colonoscopies represent such an outrageous expense because–unlike hip replacements, C-sections, or even nasal spray–everybody is supposed to get them. And get them regularly.

In the U.S., we spend a whopping $2.7 trillion per year on preventative healthcare. That is more than the U.S. government’s annual deficit.

Colonoscopies are a case in point.

It is–by far–the most expensive cancer screening that Americans are urged to undergo. Plus, doctors often prescribe colonoscopies much more frequently than medical guidelines recommend.

Meanwhile, the NCI ignores the far less expensive and more effective screening test for lung cancer.

Ten to 15 years ago, doctors performed colonoscopies in their offices. And only on patients at high risk for colon cancer. Or on patients with intestinal bleeding.

Then, doctors discovered they could detect early cancers in people not at high risk and without bleeding. But they never compared their success rates with colonoscopy to their success rates with other easy and available screening tests.

Why not use the occult stool test, which checks for hidden blood in the stool? And what about sigmoidoscopy, which only enters the lower large intestine where most cancers occur?

These two tests are much less expensive and less dangerous than colonoscopy. Plus, they are equally as effective in detecting cancer. Why don’t doctors recommend these instead?

Most medical practitioners pick the most expensive and dangerous option without any scientific data to support it. In fact, no study has shown that colonoscopy prevents colon cancer incidence or mortality any better than these other screening methods.

In March 2000, Katie Couric had her first colonoscopy performed on national TV. Soon afterward, patients began demanding them like the latest cosmetic procedure. The American College of Gastroenterology (ACG) even successfully lobbied Congress to have the procedure covered by Medicare with taxpayer dollars. No wonder the ACG wholeheartedly declares colonoscopy the “preferred” approach to colon cancer prevention. It certainly seems preferred when it comes to collecting membership dues.

So now, when you become eligible for Medicare at age 65, you get a “free” colonoscopy. Just think, with the 15-year lag time for a polyp to turn cancerous, this Medicare benefit should keep you in the clear until you turn 80. If you’re any older than 65, you may want to think twice before bending over to your doctor’s orders. (Just doing the math!)


1. “The $2.7 Trillion Medical Bill,” The New York Times (, 6/1/2013