Fear of this screening could cost you your life. Don’t let it.

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PHOENIX (City of Hope, Phoenix) – Of all the recommended screenings and tests doctors like us to do, the colonoscopy is probably the most dreaded. It’s also one of the most important. According to City of Hope, colorectal cancer is the second deadliest cancer in the U.S. It’s also highly treatable when doctors catch it early before it has spread. At that stage, the five-year survival rate for colon and rectal cancer is 90%. That’s more than worth any temporary discomfort or anxiety.

“Colorectal cancer is one of the most curable cancers, yet research shows tens of millions of people are skipping out on potentially lifesaving screening,” according to City of Hope. “The biggest reason is fear - fear of bowel preparation, fear of the test, fear of the results.”

Don’t let that fear cost you your life.

Watch: March is Colorectal Cancer Awareness Month

“Colorectal cancer is common. And colorectal cancer can be deadly,” says Dr. Toufic Kachaamy, Interventional Program Specialist, Chief of Medicine and Director of Gastroenterology and Endoscopy at City of Hope, Phoenix. About 151,000 people will get colorectal cancer in the U.S. this year. It’s the second leading cause of cancer death in men and the third in women.

Technology has come a long way and is improving every day. Because of that, colorectal cancer has declined overall and patients are living longer, better lives. But that’s not the whole story.

“We’re preventing a lot of colorectal cancer, but there has been a shift to younger adults – the folks we did not screen in the past,” Dr. Kachaamy explained. That’s not exactly new. Dr. Kachaamy says. The incidence of colorectal cancer in people younger than 50 has been steadily increasing for the past two decades. “We’re seeing patients younger and younger with colorectal cancer. The median age of diagnosis has shifted from 77 to 66.”

Why? And what can I do to lower my risk?

Doctors are not exactly sure why more younger adults are being diagnosed with colorectal cancer, but say lifestyle likely plays a part.

Research suggests that a diet that includes frequent fast-food meals might affect the balance of good and bad bacteria in your colon. That kind of imbalance in the gut has been linked to autoimmune diseases such as Crohn’s disease, as well as multiple sclerosis and heart disease. It’s unclear if there’s a similar link to cancer, but researchers suspect poor gut bacteria might contribute to obesity, which is a leading risk factor for colorectal cancer.

Lifestyle is something you can control. It comes down to making smart decisions every day.

“The easiest thing to remember is what’s good for your heart is good for your colon,” Dr. Kachaamy says. A healthy lifestyle includes being physically active and eating a diet with lots of fruits and veggies. Doctors also suggest limiting red meat and highly processed foods, as well as avoiding excessive alcohol. The National Institute on Alcohol Abuse and Alcoholism, part of the National Institutes of Health, defines “heavy alcohol use” as four drinks on any day or more than 14 drinks per week for men and three drinks on any day or more than seven drinks per week.

Not smoking and not being overweight or obese are also parts of a healthy lifestyle.

But no matter what we do, there are cancer risks we cannot control, including genetics and family history. When sharing your family history with your doctor, you must be specific.

“If you have a first-degree relative who had a high-risk polyp removed, then you should be screened earlier,” Dr. Kachaamy explained. “We think about one-third of premature colorectal cancer can be prevented this way.”

When should I get screened?

The Centers for Disease Control and Prevents suggests you start regular screens when you’re 45. But as Dr. Kachaamy said, you’ll want to talk to your doctor about starting earlier if you have a family history.

The good news is that a colonoscopy is not the only way to detect colorectal cancer. Thank you, technology.

Dr. Kachaamy says there are stool tests that you can do at home. Those tests mainly look for two things: blood in the stool or the presence of DNA markers associated with colorectal cancer. This kind of test is convenient. You don’t have to do any prep or take a day off work. But there is a drawback. Stool tests must be repeated every three years or even as often as every year.

“If you get a colonoscopy and it’s normal, you’re good for 10 years,” Dr. Kachaamy says.

So, The Procedure. What do I need to know?

Colonoscopy is still the gold standard for detecting colorectal cancer, and as scary as the procedure might sound - “They’re going to put what where?” - it’s not nearly as bad as many think.

“The toughest part of the procedure is prepping for it,” Dr. Kachaamy explained. “You have to drink a large quantity of water to clean your colon out so we can see it well.”

Your doctor will ask you to switch to a low-fiber diet three days before your procedure. One day before going in, you’ll move to an all-liquid diet. The doctor will have you drink a laxative drink the night before your procedure. Unpleasant? Yes. Doable? Absolutely. It’s short-term discomfort and inconvenience for long-term, possibly lifesaving gain.

The prep takes some planning, but you need to do your part and follow your doctor’s instructions to make it easier for them to do their part.

When you go in, the team will place an IV to give you sedation. You’ll fall asleep before the procedure begins. “That’s going to be the last thing that you remember,” Dr. Kachaamy said. “What everyone needs to know is during the procedure, you’re not aware of anything that’s happening.”

Once you’re out, the doctor will insert a flexible tube with a light and tiny camera on the end and take a look at what’s going on inside your colon. They are looking for polyps, which Dr. Kachaamy describes as “small mushrooms inside the colon.” Polyps can be benign. They also can be a precursor to cancer. If there are polyps, the doctor can usually remove them during the procedure.

A colonoscopy is an outpatient procedure that’s usually finished in about 30 minutes. You should wake up feeling fine, but shaking off the sedation takes a bit of time. Your doctor will send you home and advise you to rest. No going back to work, driving, or doing anything strenuous.

Before your schedule your colonoscopy

Dr. Kachaamy says you want to be sure you’re getting a “quality colonoscopy.”

“It means that the physician performing the procedure has spent their time looking at as much as possible of the colon – behind folds and areas where things can hide,” he explained.

Because polyps can be subtle, City of Hope doctors use artificial intelligence to help them find anything that might be problematic. The AI decreases the chance of something being missed.

Dr. Kachaamy suggests you ask the doctor who will perform your procedure about their adenoma detection rate. That is “the measurement that best reflects how carefully colonoscopy is performed,” according to the American College of Gastroenterology. “This rate should be at least 25% in men and 15% in women. A secondary measure of careful examination is that doctors should have an average withdrawal time of at least six minutes.”

The withdrawal time is important because that’s when most doctors look for polyps. You want them to take their time and be thorough. City of Hope’s doctors are.

If you’re nervous about asking a doctor for proof of performance, so to speak, don’t be.

“It is perfectly reasonable to expect doctors to have measured their adenoma detection rate and to record their withdrawal time,” the American College of Gastroenterology says. That’s why Dr. Kachaamy advises people to ask for the information. City of Hope is proud of the care it gives each patient and encourages people to talk to their doctors and ask questions. They believe good health care is a partnership.

Back to the procedure. Are there risks?

“The procedure itself is very safe,” Dr. Kachaamy says. “It’s one of the safest procedures we have.”

But there are risks. There are always risks with medical procedures. There are risks in getting out of bed every morning.

“You have to look at the risk and the benefit,” Dr. Kachaamy says. “What are you gaining by taking that risk? For example, we all drive every day. The risk of dying in a car accident in the United States is 1%. A colonoscopy is much safer than driving.”

I’ve been having some bowel issues. Should I be concerned?

“Anything different with your bowel habits should be a reason to get checked,” Dr. Kachaamy says.

One thing you should never ignore is bleeding.

“Bleeding is never normal. You have to get checked. A lot of times, it’s not cancer, but do not ignore it.”

Blood in the stool might not look like you think it would. It can be shiny black or bright red “or anything in between,” according to Dr. Kachaamy. “Anything other than brown or green means you should get checked.”

If you see blood but you feel fine, Dr. Kachaamy says it’s OK to call your primary care doctor. If there’s a lot of blood, you don’t feel right, or you are dizzy, a visit to an emergency room might be in order.

Other symptoms you’ll want to pay attention to are unintentional weight loss, constipation, mucus in the stool, and abdominal pain.

Why City of Hope

“First of all, we’re going to treat you like family because we take pride in how we take care of our patients,” Dr. Kachaamy says.

That’s true across every department at City of Hope, formerly Cancer Treatment Centers of America.

“We care about our patients,” mammographer Elisha Turner told us in November. “We want them to feel that we know them and we understand them. We really want them to know when they go home that they are being taken care of.”

“Our patients often have consulted with centers throughout the country, but elect to come to City of Hope for their surgery and treatment because we analyze every individual situation in a multidisciplinary team and push the envelope where others might stop,” explained Dr. Andreas M. Kaiser, Professor and Chief of the Division of Colorectal Surgery at City of Hope.

“We were known as Cancer Treatment Centers of America,” Dr. Kachaamy said. “We’re now City of Hope. We’re now one of the largest cancer care health systems in the country. For patients, what it means is access to more treatment options, more clinical trials, more cutting-edge treatments, and more hope.”

And what does hope mean to Dr. Kachaamy?

“Hope means with time, we are getting smarter, we have better technology, we understand science better, and we can save more lives, and, more importantly, improve quality of life,” he said with a smile.

“I also hope that for anyone who is diagnosed with this disease – which can be a horrible disease – that it becomes a blip or a bump in their life, and they get over it and they continue on.”

About City of Hope

City of Hope, one of U.S. News & World Report’s top 10 “Best Hospitals” for cancer, is dedicated to making a difference in the lives of people with cancer, diabetes, and other life-threatening illnesses. With a mission to deliver the cures of tomorrow to the people who need them today, City of Hope’s growing national system includes its Los Angeles campus, a network of clinical care locations across Southern California, a new cancer center in Orange County, California, and treatment facilities in Atlanta, Chicago, and Phoenix. With an independent, National Cancer Institute-designated comprehensive cancer center at its core, City of Hope brings a uniquely integrated model to patients spanning cancer care, research and development, academics and training, and innovation initiatives.