Sigmoidoscopy vs. Colonoscopy

Colonoscopies Can Cut Disease's Death Toll, But Many People Don't Take Advantage Of Them

Dear Stephen,

Several months ago, President Bush was put under anesthesia for a highly publicized colonoscopy—a procedure that involves using a long, thin tube with a video camera and a light on the end to look inside the entire length of the colon. In response, my friend Albert Sanchez, Ed. S. (educational specialist), Ph.D., wrote an open letter, which I'd like to share with you today.

You see, one of the travesties of modern medicine is that some HMOs and insurance companies are risking our lives because they pay only for sigmoidoscopy, a procedure that uses a much shorter tube to look at the inside of the rectum to the last part of the colon. So here we have a screening tool that allows colon cancers to be caught and treated at earlier stages, and yet the so-called payers of health care often won't pay for it.

Furthermore, studies performed in the U.S. and Europe have demonstrated that in the last ten years colon cancers have been occurring more frequently on the right side of colon, near the appendix, rather than further down toward the rectum. The reason for this shift in geography is unknown, but it means that more extensive screening tests such as colonoscopy must be done to investigate the colon throughout its length.

But don't take it from me; I want you to hear from Dr. Sanchez, who has been personally touched by health insurers' failure to pay for this important screening exam. Now here's Dr. Sanchez.

"Everyone has now heard that President Bush had a colonoscopy for preventive reasons. He has, in fact, urged the general public to do likewise. However, without adequate insurance and health care, how can people of low income afford this procedure?"

"There are now [44 million] Americans without health insurance. Equally disturbing, those already enrolled in some HMOs will discover that most organizations and doctors recommend sigmoidoscopy over colonoscopy—even when a specific history of colon cancer exists.

"Regarding the publicity that President Bush has given colonoscopy exams, the reality remains that only a minority of patients manage to receive this particular cancer test. Too many doctors and hospitals still recommend the sigmoidoscopy, which has a failure rate of 51 percent in colon screening [because] it covers only the rectum and the lower 2 feet of the bowel. The sigmoidoscopy is preferred by insurance companies, especially HMOs, due to its lower cost…"

Loss of Loved Ones

"Several years ago, my beloved wife suffered an untimely death due to colon cancer, and later my darling daughter also succumbed to the disease. Due to this, I decided to immerse myself in private cancer research. [Dr. Sanchez was an educator, but after he lost his wife and daughter, he became director of the Advanced Medical and Research Center (AMARC), which distributes the anti-cancer compound Poly-MVA in the United States.]

"If a mother or father has had cancer of the colon, then [their children] should start having [regular] colonoscopies by age 30. My wife died at age 34, and by the time they were 30, three out of my four children had [colon] polyps. The one child who was denied a colonoscopy and who was given a sigmoidoscopy instead died of colon cancer—a tragedy that could have been prevented."

Practice Smart Medicine

I agree with Dr. Sanchez and also recommend colonoscopy rather than sigmoidoscopy to my patients. I prefer colonoscopy because it allows for the examination and removal of accessible polyps along the entire colon.

The big downside is that colonoscopy is a far more expensive and involved procedure, and therefore many doctors prefer to perform sigmoidoscopy as a first step. But if you are at high risk for colon cancer, I'd strongly urge you to ask your physician about going directly to colonoscopy. By "high risk" I mean that you have a first-degree relative like a parent or sibling with colorectal cancer, which increases your lifetime risk of developing this disease. So does a high intake of unhealthy dietary fat and a sedentary lifestyle. Cancer also occurs more often in anyone who has a history of bowel disease such as diverticulosis and diverticulitis.

But there's more to avoiding colon cancer than getting screened on a regular basis. Your lifestyle plays a crucial role, too. Learn more about how you can take charge of your bowel health by reviewing my six tips.

In the cost-conscious health care system we have today, few are going to look out for you and your individual needs, so it's up to you to practice smart medicine yourself. Demand a colonoscopy if your family history warrants it, and take every step you can to maintain a healthy, highly functioning bowel.

Until next time,

Stephen Sinatra, M.D.