Spotlight on your colon

PORTLAND – Any pitch for colonoscopy runs up against a medical paradox:

The most effective screening for deadly cancers comes before symptoms show up, when the person feels well.

Which helps explain why Larry Harvey, feeling fine, lay on a gurney for about an hour recently so a doctor could insert a flexible scope through his anus to inspect and photograph the entire 5-foot length of his colon.

“You don’t get up in the morning and say, ‘Oh boy, today’s my colonoscopy!’ ” says Harvey, a community relations consultant from Vancouver, Wash. But he also felt lucky to be undergoing the test when he has no symptoms.

“I just hope somebody sees this and says, ‘Gosh, it’s not so bad.’ “

Harvey says he agreed to have his “live colonoscopy” videotaped, to be posted later on a public health Web site for educational use, for two reasons: First, he was overdue. Second, he hoped to send a message that the procedure isn’t half as bad as its woeful reputation.

Actually, there’s a third reason. A publicist for the Oregon Partnership for Cancer Control told Harvey last month about the colonoscopy promotion and asked him whether any of his 50-something friends would volunteer.

The short answer: No. And a somewhat sheepish Harvey realized that he squarely fit the colon cancer risk profile.

“I’m 58,” he says. “I’ve never had the test done. My parents died of cancer. I have a history of colitis.

“This is the right time.”

The Partnership for Cancer Control chose to highlight colonoscopy because it offers the best chance of saving lives from a cancer that is both lethal and largely preventable.

In case colonoscopy “stuntman” Harvey can’t convince you himself, here are some stark numbers on his side:

Colorectal cancer kills more men and more women than any other cancer except lung – about 50,000 a year nationwide.

Treatment – and survival – depend on when the cancer is found. At Stage 1, the cancer remains wholly within the colon. At Stage 2, it has penetrated the bowel wall; at 3, it has invaded the lymph nodes; and at 4, it has spread to other organs.

The difference in survival rates between Stage 1 and Stage 4 is enormous. More than 90 percent of people diagnosed with Stage 1 colon cancer can expect to live at least five years. More than 90 percent of people diagnosed at Stage 4 can expect to die within five years.

Doctors have several ways of testing for colon cancer. The most thorough tests use a flexible, lighted scope containing a miniature digital camera to inspect the lining of the colon.

Colon cancer usually starts with a small, benign mushroomlike precancerous growth called a polyp. Polyps may not become malignant for as long as 10 years – a window of opportunity for cancer prevention. One advantage of colonoscopy is that if the scope detects precancerous polyps, they can be snipped immediately and removed without a second operation.

“You screen not so much to find the cancer but to find the polyps that could become cancerous,” says Dr. Katrina Hedberg, a medical epidemiologist in the Oregon Public Health Division.

In Harvey’s case, Dr. Derek Taylor told a hospital spokeswoman that he removed two polyps, which will be examined.

Colonoscopy is the most complete and effective test. But it’s also the most expensive and invasive, and what is euphemistically called “the prep” is off-putting to say the least. It involves fasting and drinking a foul-tasting laxative to clean out the bowels before the scoping, which is done under sedation.

The guidelines for colorectal screening get complicated, and not every doctor agrees on all the details. The four basic types of tests have advantages and drawbacks. But here’s the gist: Everyone past 50 should have some kind of colon test. To see more about screening: www.cdc.gov/cancer/colorectal/basic – info/screening

Another glaring statistic drives the prevention campaign highlighted by Harvey’s colonoscopy: Fewer than half the people most at risk of colon cancer – older than 50 or with a family history of the disease – get any kind of colon test.

“If someone feels sick, they want to go to the doctor and get better,” says Hedberg. “But it’s very hard to get people to take time out from a busy schedule to get screened when they don’t feel bad.

“That takes some convincing.”

Public health doctors have a saying:

What’s the best test?

The one that actually gets done.