A consultant surgeon on getting the letter, getting the test, and what I wish more people knew before they open the envelope.
Anyone over 50 will be familiar with the envelope. Every couple of years the bowel screening programme invites you to provide a stool sample, testing for microscopic traces of blood. For the first few rounds it was a minor inconvenience, and the result came back negative each time.
Then at the last round it wasn’t the negative result I was expecting it was positive and the recommendation that I have a colonoscopy.
It was a worrying time. Like many people before me, I assumed the worst: I must have cancer. Logically, I knew this wasn’t likely but logic and anxiety don’t always occupy the same room.
What gets lost in that anxiety is the single most important thing about this test. Colonoscopy doesn’t only detect cancer. It can prevent it.
Most bowel cancers start as harmless polyps
Most bowel cancers begin as a polyp — a small, benign growth on the bowel lining. Polyps are common, and they grow slowly, typically over many years. The larger a polyp becomes, the more likely it is to cause problems and, in particular, the more likely it is to transform into a cancer.
This slow progression from polyp to cancer is the rationale for bowel screening: find polyps early, remove them at colonoscopy, and the cancer that polyp might have become simply never happens.
Removal does something else too. What we find tells us about your future risk — whether you’re someone who is likely to form further polyps, and how closely you should be followed up.
Three possible outcomes.
When it comes to polyps and cancer, a colonoscopy has three possible results:
1. Nothing is found. No polyps, no cancer. Either everything is normal, or there’s another explanation for the blood such as: diverticular disease, haemorrhoids, or inflammatory bowel disease.
2. A polyp is found and removed. A potential cancer has been prevented, and you leave with useful information about your future risk.
3. A cancer is detected. This is nobody’s hoped-for outcome but a cancer found through screening is very likely to have been found at a stage where treatment is effective. This is far better than one that declares itself years later, when the options are narrower.
The only outcome with no upside is the one where the test never happens.
What it was actually like
After a great deal of angst, I had my colonoscopy. Honestly, it was far easier than I had imagined. The preparation is the part people dread, and it isn’t glamorous, but the procedure itself was straightforward and over quickly.
And after all that worry, I’m glad to say I had haemorrhoids and nothing else.
If you’re sitting on a positive screening result, or an unopened envelope, I’d say this: the anxiety is normal, it’s real, and it is very nearly always worse than the test. Book it.
[Author byline — e.g. Ken Park is a consultant surgeon and Chief Medical Officer at NexEndo Healthcare.]