Because of this, most physicians and specialty organizations recommend screening colonoscopy (meaning checking before symptoms occur) starting at age 50, or earlier if a family history of colorectal cancer exists. Screening colonoscopy is endorsed by numerous societies, including the American Cancer Society, the National Cancer Institute, the American College of Gastroenterology, the American Medical Association, and the American College of Physicians. As such, we have established a direct referral line for screening colonoscopies.

The indications for colonoscopy would be if you:

1. Are over age 50 without symptoms.
2. Are over age 40 with a family history of colon cancer.
3. Have a change in bowel habits.
4. Have rectal bleeding.
5. Have abdominal pain.

To schedule a screening colonoscopy call 317-834-2020 (Mooresville office) or 317-889-7906 (South Indianapolis office).

• Did you know that insurance generally covers screening colonoscopies?
• Colon cancer is the second leading cause of cancer deaths in the United States.
• Six percent of people will develop colon cancer in their lifetime.
• Colon cancers virtually always start as a colonic polyp.
• Colon cancer is almost completely preventable by removing polyps.

Colon and rectal cancer can occur at any age, though most people develop these tumors over the age of 40 with the risk increasing as we age.

As these polyps go on to increase in size, they have the potential of turning into a cancer and at that point invade and spread through the bowel wall and into the body. These changes of a polyp turning into cancer typically take 5-10 years. Fortunately, not all polyps go on to develop into a colon cancer.

Polyps very rarely cause symptoms and most colon cancers do not produce symptoms until they are large and advanced. Therefore, it is recommended that people get checked for colon cancer at designated ages even in the absence of symptoms.

Though there are many ways to screen for colon cancer, it has now been well established that the most accurate test for detecting colon polyps and colon cancers is colonoscopy. If the colonoscopy is normal (and no high risk individual/family risk factors exist) it should be repeated once every 10 years, though if polyps are found, colonoscopy needs to be repeated in 3-5 years after the initial colonoscopy depending on the size and type of polyps.

A colonoscopy is a safe and effective means of visualizing and examining the entire lining of the colon and rectum. It is also an effective means of removing a polyp utilizing colonoscopic snares or forceps. We typically perform our colonoscopies under IV sedation and on an outpatient basis in any of several state of the art endoscopy centers or surgery centers with minimal inconvenience and discomfort.

In order to perform a colonoscopy the bowel must be thoroughly cleaned of all residual bowel movement (feces). It is important that this preparation be done the evening before. Currently, there are several ways to clean the bowel based on physican preference and patient medical conditions; options will be reviewed with you in advance. The entire procedure usually takes less than half an hour. There should be little, if any discomfort.

In addition to detecting colon polyps and cancer, colonoscopy can also evaluate other disorders of the colon, including diverticulosis and inflammatory bowel disease (Crohn’s disease or ulcerative colitis). Colonoscopy is frequently used to evaluate and check persons with unexplained abdominal symptoms, anemia, diarrhea, constipation, rectal bleeding, or positive hemoccults (a method of detecting hidden blood in the bowel movement).

Though colonoscopy is very safe (our surgeons have collectively performed well over 25,000 colonoscopies), there are risks, including bleeding and colonic perforations. These risks are very rare (less than 1 in 3,000) and are typically recognized within 24 hours of the procedure and treated accordingly.

In the United States, the current cumulative lifetime risk of developing colorectal cancer is approximately 6%, with the risk of dying from colorectal cancer being approximately 3%. Despite the large number of patients with this disease, there is increasing evidence indicating a gradual decline in mortality. Many experts feel this trend may be a result of early detection as screening (checking for colon cancer at designated time intervals before symptoms occur) becomes more widely practiced in the United States.

Fecal occult blood tests (also known as hemoccults) are a commonly used screening modality, and have been noted to decrease colorectal cancer mortality in at least one large study. Unfortunately the number of false negative tests is also high. Fecal occult blood testing misses approximately 40-50% of colorectal cancers, and misses nearly 80% of all adenomatous (precancerous) polyps. Most experts feel the true benefit of fecal occult blood testing results from the chance selection of patients for colonoscopies. Nevertheless, it remains an accepted standard screening modality for colorectal cancers.

Because the incidence of polyps and cancers in the proximal (right) colon has increased, some authors advocate colonoscopy as the best screening modality. Recently (July 2000) we participated in a study published in the New England Journal of Medicine noting a higher than anticipated number of proximal neoplasms in those patients without distal colonic pathology. This study adds further support to an increasing body of evidence suggesting that colonoscopy be considered as a screening modality for colorectal cancer.

In a recent study, Rex, et al. performed colonoscopy in 210 asymptomatic individuals between 50 and 75 years of age with no known risk factors for colorectal neoplasms and a negative fecal occult blood test. Significant adenomas (1cm or more in diameter) were found in 25% of patients as well as two colon cancers.

The justification for the use of colonoscopy as a screening modality rests in the theory of the origin of colorectal cancers. It is known that greater than 90% of all colorectal cancers start out as adenomatous polyps. One attractive aspect of the use of colonoscopy for screening is that it is also therapeutic by removing the colonic polyps. This avoids subsequent procedures, as is necessary when barium enemas are used. Certainly, any program for colonoscopy "screening" would have to be based on certain assumptions about the rate of growth of polyps and the length of time required for malignant transformation. A number of studies estimate that it takes an average of five to seven years for transformation of a 1 cm adenoma to colon carcinoma. Thus, colonoscopic polypectomies could prevent cancer, even if screening intervals were somewhat prolonged.

In conclusion, utilizing colonoscopy as a screening modality in asymptomatic average-risk patients is gaining support in the cancer prevention literature. The literature makes a very strong argument that for patients with an increased risk of colon cancer (family history of colon cancer, personal history of colonic polyps, history of inflammatory bowel disease of personal history of breast, ovarian or uterine cancer), utilizing a colonoscopy offers the most accurate and complete exam. Patients at average risk should be at least considered for screening with colonoscopy or at a minimum should undergo a flexible sigmoidoscopy and fecal occult bleed testing. Medicare as well as most commercial insurance carriers now covers colonoscopy as a screening modality for colon cancer.