Dave Barry: A journey into my colon - and yours

[bennevisplace]

A plagiarised version of an article by Dave Barry, published in the Miami Herald in 2008, appeared in one of my newsfeeds recently. I thought I'd share it here, as the message for 50-74 year-olds: screen yourself for colorectal cancer, is as relevant today as it was fifteen years ago. Those of us with weakened immune systems and at increased risk of secondary cancers should need no further encouragement.

There's also an introductory video to virtual colonoscopy, aka CT colonography, a less invasive and less costly alternative to colonoscopy as a screening tool for people who are not already in a high-risk group for colorectal cancer. Since the UK guidelines for periodic screening by colonoscopy have been re-written, raising the bar so as to exclude many people previously classed as high-risk, screening with NHS colonography is a possibility individuals might explore.

But the main reason to read Dave Barry's article is that IT'S HILARIOUS.

miamiherald.com/living/liv-...

If the above link takes you a paywall, try googling Dave Barry colonoscopy and the same link should be top of the list. Some times you have to sneak in by the main entrance!

Anyway, the virtual colonoscopy video is on

youtube.com/watch?v=5Xj7Yzn...(Not working as expected?)

[LeoPa]

There is a cheap stool test that is looking for traces of blood in the stool. If any is found then a colonoscopy is warranted. Over here it's done every 2 years as part of the preventative check-up of the population.

[bennevisplace in reply to LeoPa]

I'm glad you mentioned that. The faecal immunochemical test (FIT) is the standard test used in screening programmes for colorectal cancer (CRC) in many countries, the UK and Australia to name but two.

Here in the UK the NHS sends out a FIT kit every two years to all those registered, in the deemed "at risk" age range 60-74. About 30% of kits are not returned. Of those that are, about half fail to detect an actual cancer, and 3/4 fail to detect a precancerous polyp. The programme has improved CRC detection rates but has made little impact on CRC mortality rates in the UK.

My Australian friend diligently returned her FIT kits (they start screening at age 50), was independently diagnosed with stage 4 CRC and died within a year.

I have two risk factors above the norm: family history and CLL. Under the new UK guidelines I am assessed as "at very low risk" of CRC and no longer eligible for 5-yearly colonoscopy. Nevertheless, it is recommended I should continue to return a FIT every two years until I'm 74. The option of CT colonography has never been mentioned.

[Skyshark in reply to bennevisplace]

UK is extending the test down to 50 year old. At present 56 and 58. This recommendation was made in 2018 but they only started acting on it in 2021.

nhs.uk/conditions/bowel-can...

[bennevisplace in reply to Skyshark]

Thanks for pointing that out. It's a good thing of course, because more people will be diagnosed earlier.

I think the biggest unmet need is an effective mass screening test, i.e. one that healthcare systems around the world can afford to administer to all 50-75s, with a sensitivity >2/3 in detecting CRC and precancerous polyps >10mm diameter. The FIT is not it.

[LeoPa in reply to bennevisplace]

I did not know that the detection rate was so poor with the FIT test 😔. Given the cost of colonoscopy I guess there is no good solution to the problem other than prevention. To perform it on everyone every 5 years, there would not be enough money nor specialists. Perhaps that is why there is the FIT filter. Why you don't qualify for the test with the family history and CLL , I have no idea.

[bennevisplace in reply to LeoPa]

The figures I quoted apply to the FIT screening programme in England, see journals.sagepub.com/doi/10... Abstract, Results. Theoretically such a programme can achieve a higher aggregate sensitivity simply by moving the goalposts, i.e. lowering the minimum concentration of faecal haemoglobin required to signify a positive result. That way, more people are sent for confirmatory colonoscopy, more CRCs are confirmed. But more healthy guts are found too, which to the NHS is a waste of resources.

[blowinginthewind]

I had a CT colonoscopy last week, and I am having a flexible sigmoidoscopy tomorrow. I am on active monitoring for my CLL. But a few weeks I started with an intermittent bowel problem. GP sent off samples and wanted to send me on 2 week referral but I wasn't keen on that. All samples for GP came back as ok. There is a massive family history of bowel cancer, and it is all in the same line. So I accepted 2 week referral. I am not anxious about actually having the tests, I am anxious about the results. Consultant and I talked about type of colonoscopy, and he said that he wanted to make sure that there were no lymph nodes or an enlarged spleen etc affecting passage through my gut. All the information will then go to my haematologist; this hospital are good at getting information quickly to Christie.

I always do the stool tests which come through the post every 2 years, but it is now nearly 2 years since the last one.

Liz in Manchester UK

[bennevisplace in reply to blowinginthewind]

Hi, thanks for your input. I hadn't thought of the particular value of CT colonography for CLL patients with possible involvement of lymph nodes or spleen in bowel issues.

Was the sigmoidoscopy directed by the interpreted CT scan, or are you going to get your results as a package, through your haematologist?

In any case, with your family history close monitoring, distressing though it may be, has to be in your best interest. Results-wise, fingers crossed for you.

[blowinginthewind]

I have no results yet from the CT Colonoscopy, but they are supposed to take 2 weeks. I am having the sigmoidoscopy because I had one some years ago, and there were some very tiny diverticuli in there - literally less than a dozen and tiny. But it will give us the opportunity to see what they are doing, and also to take biopsies to check for inflammatory bowel disease. I will be given the results of the sigmoidoscopy tomorrow. To be fair, myself, my GP and the consultant are pretty sure this is IBS. But that needs to diagnosed by a process of elimination rather than assumption.

I just hope that I will soon be able to carry on life normally - I am not going out much because of the symptoms.

Liz in Manchester

[DebDenC]

I Have read Dave Barry’s article many times over the years. My husband routinely sends it to people facing a colonoscopy. I would like to add that in thecUS, guidelines have changed to begin colorectal screening at 45 instead of 50. My son in law is a colorectal surgeon and is working hard to get that message out. Colon cancer is appearing in younger people more often, hence the new guidelines.

[happyclappy]

So glad you said main entrance and didn't lower yourself to say "back door!" 😳

[bennevisplace in reply to happyclappy]

😆(penny dropped)