Interviewer: Colonoscopy has reduced deaths from colorectal cancer up to 70% but yet some people still don't have them done. Can they help you overcome some of the common barriers that people face to getting a colonoscopy next on The Scope.
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Interviewer: Dr. Kathleen Boynton is a gastroenterologist at University of Utah Health and colonoscopy is one of these instances where it's a really good tool for prevention but a lot of people still choose not to use it. What are the reasons and how can we overcome some of those barriers? Dr. Boynton, I guess there's five of them so let's just start with number one.
Dr. Boynton: I think it's probably fair to say that perhaps what we need to be doing as a medical establishment is doing a better job of informing patients about why we emphasize colonoscopy screening. We know that colonoscopy, as you mentioned, is effective at cancer prevention in up to 70%. In other words, your reduction and the likelihood of getting colon cancer is decreased by 70%.
Interviewer: Yeah, it's one of the most deadly cancers but yet, one of the most preventable but only if you get the colonoscopy.
Dr. Boynton: Right, right. And it's a tricky thing because most people assume that cancer causes symptoms but not necessarily and that's why we do screening. We recognize that for both breast and colon cancer for instance, you don't have symptoms. When you get symptoms is generally when the disease is advanced and your window for cure is gone. So when studies are done to look at how is colon cancer affected by getting a colonoscopy, we see that the decrease and likelihood is substantial.
Interviewer: So sometimes it can be a little overwhelming. As a patient, it feels like there's all these screenings and tests we have to take which is not necessarily always the case. However, colonoscopy is one of those that really we know is really effective at preventing a disease. So that's the first thing is a lot of people don't realize the importance. Number two, this is a common one I hear, the preparation is tough. You have to drink all sorts of stuff and it takes a day of preparation. Explain that a little bit.
Dr. Boynton: Yeah, well, I do not mean to sound as though I'm making the experience a trite one. I think it is a very difficult prep but in my mind, it's worth the investment. As difficult as it is, I think it's worth it to go through that experience for that reduction and risk. And keep in mind, the risk reduction, let's say it's 70% risk reduction, if I tell you you don't have to come back for 10 years, I'm telling you you have a 70% decline in your likelihood of colon cancer for the next 10 years. That's pretty profound.
Interviewer: Yeah, for a 12-hour, 24-hour investment of your time. Who wouldn't do that, right? The return on investment on that is really good. So the preparation can be tough for some people but the return on investment is really, really high and it's probably not as bad as a lot of people . . .
Dr. Boynton: Yeah, we get the gamut of experiences but I think it's fair to say we generally have a couple of patients everyday who say it's not nearly as bad as I thought it was going to be.
Interviewer: All right, number three, one of the barriers to people choosing to get a colonoscopy is just the fear of the unknown, like there's a lot of scary things involved with this, least of which is, "If I have cancer, I don't know that I want to know that I have it." So what about pain? I would imagine a lot of people fear that they don't know if it's painful or not.
Dr. Boynton: Yes, yes. My answer if patients ask me about the likelihood of pain, I generally say, "The possibility that's going to happen is very low that you're going to experience any discomfort at all." In very unusual circumstances if somebody has a complication related to the pain medication, we may back off, but that's decidedly an exception to the rule. Generally, it's painless to go through this.
Interviewer: And back to the main point. One of the biggest fears is, you know, that diagnosis can be kind of scary. Maybe I'd rather not know. Do you run in to that a lot?
Dr. Boynton: Yeah, and I can sympathize with that. I don't want to go to the dentist because I'm afraid I'm going to have something wrong.
Interviewer: Yeah, like a cavity which . . .
Dr. Boynton: Yes.
Interviewer: This is something quite a bit, a lot worse, right?
Dr. Boynton: Much. Very much so. But in this case, again, I get back to the idea of why we do this exam. Generally, when I find it on a scope, it's a curable lesion and many times, we can remove it at that time.
Interviewer: Don't even have to come back.
Dr. Boynton: Right. Even if it's an early cancer, we can take it out.
Interviewer: Reason number four, it can be a bit of an invasive experience and some people are afraid of that.
Dr. Boynton: Yes, yes.
Interviewer: What do you say to that?
Dr. Boynton: I think that is also in a sense related to that whole fear of the unknown. We've taken in breast cancer and colon cancer, we're kind of screening in very personal areas of the body and I think for a lot of patients, just this idea, this concept in their mind of what we're about to do, much less with people you've never met before, is pretty daunting. At the same time, I can say with great assurance that, at least here, we are very aware of how complicated this is and very sympathetic with how invasive this seems. We're investigating a very private area of the body, how is this going to happen in a way that's not awkward or embarrassing? So the link that we've provided on our website is actually a reenactment of going through the prep and the colonoscopy, and hopefully it serves to reassure people that we are very aware of the hesitations people have about this.
Interviewer: And then finally, the cost. There can be some confusion sometimes as to what the insurance might cover, what it might not cover for those without insurance, how they pay for it so . . .
Dr. Boynton: Right. So the university will investigate this issue on their own as well as you can call your insurance company and find out what your limitations are. We are very happy to work with people that have certain limitations provided by their insurance. Generally, screening is covered on insurance.
Interviewer: And they're getting . . . even if you might have to pay a little bit more, as far as all the tests that are out there in the world, this is really one that could make a difference in the quality of your life, not only just the longevity but the quality of it.
Dr. Boynton: Yes. The co-pay for a colonoscopy is much less than the co-pay for colon cancer.
Interviewer: Right, right. So we covered, I think, a lot of barriers and of course, if people have any other personal barriers, what should they do at that point?
Dr. Boynton: When we call to schedule patients, we have a dedicated call team that schedules only these. They can leave a message with the call center that's scheduling individuals and let them know what their concerns are and we do get that message and we're very happy to work with anyone if it makes their experience easier.
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