Tips on talking to your doctor about colonoscopy alternatives

Q: I want to tell my doctor that I don’t want any more colonoscopies. I have all of your info on how dangerous they are, but I need some advice as to how to go about talking to him about this..  –  B.B., Fort Wayne, IN

Dr. Micozzi: The evidence has been mounting about the dangerous side effects of colonoscopies for many years.

Most recently, researchers have found that some endoscopic medical devices are contaminated with deadly bacteria. This problem has resulted in infections and even fatalities in unwitting patients around the country. While the suspect devices aren’t the type that are used for colonoscopies, it’s not unreasonable to think that colonoscopy endoscopes could likewise be contaminated. And the FDA appears unwilling or unable to take adequate safety measures.

When it comes to talking to your doctor about the perils of colonoscopies, first you need to determine if your doctor performs colonoscopies him or herself, or will you be referred to a gastroenterologist? If your doctor doesn’t do colonoscopies, he or she may not be familiar with the latest science.

Ask your doctor why he or she thinks that colonosocopies are virtually unused in Europe—where the evidence has led doctors to perform sigmoidoscopies instead for colon cancer screening. (They practice advanced, high-quality, evidence-based medicine in Europe.)

Then ask your doctor if you can start by taking a cheap, harmless fecal occult blood test. This involves taking a small sample of your stool at home, placing it on a cardboard test panel, and mailing it or taking it to your doctor’s office.

You can also ask about Cologuard, a new DNA test that involves the same simple stool sampling. This test was approved last year by the FDA to detect the presence of DNA potentially associated with cancer or pre-cancer.

Or you can ask about whether the new MRI scan is available in your area for screening for colon cancer. (A similar MRI scan for lung cancer screening has finally been approved by the FDA, as well as Medicare, for insurance coverage.)

In addition to these tests, there are other alternatives to colonoscopies. Only in relatively rare cases will these types of simple, safe screening procedures find something that would require you to have a colonoscopy. As the Europeans know, it’s not necessary to start with expensive and dangerous colonoscopies right from the get-go.

Finally, discuss your age with your doctor. This is probably the single most critical factor regarding your risk of any cancer, as well as the justification for performing a colonoscopy.

Many studies show there is much less justification for having colonoscopies the older you get. In fact, one of the many advantages of aging is that you can get a “get out of jail free card” when it comes to colonoscopies.