I am a bad, foolish person, and now I’m feeling guilty. A few years ago, I made an appointment for a colonoscopy, and then what happened? Work happened, and I had to cancel my appointment. The prep work for the scan is unpleasant, and I knew it was going to mess up at least a day, and I couldn’t afford the time just then.
Worse, after canceling, I didn’t make another appointment. I’m just letting it slide. You know, that’s stupid. Especially after opening the latest issue of JAMA this morning and reading an editorial, Using Outreach to Improve Colorectal Cancer Screening. Early diagnosis of colon cancer makes a huge difference in prognosis, so you’d have to be an idiot to put it off.
Colorectal cancer (CRC) is the second leading cause of cancer death in the United States, with more than 50 000 deaths expected in 2017. Screening can reduce CRC mortality, and several methods of screening are available and recommended for average-risk adults aged 50 years to 75 years. Modeling studies suggest that several different methods of screening produce relatively similar levels of mortality reduction if there is good adherence to the underlying screening program.
Despite strong evidence of effectiveness, more than a third of age-eligible US adults are not up-to-date with CRC screening, with important disparities by ethnicity, income, education, and availability of a regular source of care. Currently, most CRC screening in the United States is achieved by colonoscopy. Studies of audiotaped encounters suggest that few clinicians and patients are having high-quality, shared discussions about screening options.
Increasing screening levels to greater than 80% has the potential to prevent an estimated 200 000 deaths in the United States in less than 20 years.
At least I’m not alone in my stupidity — a third of people in my cohort have been blowing it off. That’s no excuse, of course. Knowing that there are tens of millions of people in my situation does not make it less derpy.
So…I’m going to call in and make an appointment today. There’s a long wait time around here, so I probably won’t get in until Decemberish, which is all the more reason to call now.
Much of the editorial is about how health care providers can better inform and encourage people to get screened, and assessments of the effectiveness of various methods. I’m not a doctor, so I’ll just mention that I think outreach like Crispian Jago’s cancer diary helps me realize how important this is — and although it would be convenient to complain that my local hospital should have followed up with me after my canceled appointment, the truth is it’s all on me. And on you. If you’re over 50, contact your physician and make arrangements, if you haven’t already.
It’ll be fun! Weird liquid diets and spending a day purging your bowels so they can slide a camera up your butt? How can it not be exciting?