Why Do People Avoid Colonoscopies?

May 08, 2023

It’s well-known that colonoscopies save lives – in fact, data show that they can reduce the risk of colorectal cancer by almost 80 percent. So why do so many people avoid this potentially life-saving procedure?

“Colon cancer screenings can find colon cancer early when it is most treatable or, in many cases, prevent cancer from developing,” says University Hospitals gastroenterologist Chris Pluskota, DO. “And yet, too many people still don’t get screened. As a result, colorectal cancer remains the second most common cause of cancer-related death in both men and women.”

Common Colonoscopy Myths

“As a gastroenterologist, I’ve heard all the reasons for not getting screened,” says Dr. Pluskota. “Most often, people express anxiety or fear about getting a colonoscopy. They’ve heard that the prep is difficult and are afraid the procedure will be painful.”

Other reasons people may give for delaying a colonoscopy include:

I don’t have a family history of colon cancer so I’m not at risk. The reality is that most colorectal cancers are found in people with no family history of the disease.
I don’t have any symptoms. Preventive screenings are designed to look for disease in people without symptoms. In the case of colorectal cancer, symptoms typically don’t occur until the cancer is more advanced and more difficult to treat.
Getting screened will be expensive. Screening colonoscopies and at-home tests are covered as preventive care by most insurance plans.
I don’t have the time. Colonoscopy, from check-in to discharge, takes only a few hours and the prep is done at home the day before. At-home tests only take minutes.
It’s embarrassing. If you’re uncomfortable or embarrassed talking about colon cancer screenings, rest assured that your doctor is there to answer your questions.

“I reassure patients that a colonoscopy is a very safe procedure with minimal risk and little to no discomfort,” says Dr. Pluskota. “We ensure that each patient receives the right amount of IV sedation to relax them and most have no memory of the procedure. Prep methods have also improved over the years, making it more tolerable.”

Types of Colorectal Cancer Screenings

Colorectal cancer develops from abnormal growths, called polyps, in the colon or rectum. Over time, some of these growths may become cancerous. Screening tests are designed to detect polyps and remove them before they turn cancerous and are most treatable.

There are three ways to screen for colorectal cancer:

Colonoscopy. Considered the gold standard for colorectal cancer screening, colonoscopy allows the doctor to examine the inside of the entire length of the colon. If polyps are found, they can be removed during the procedure. Colonoscopy is an outpatient procedure usually done under sedation.
FIT-DNA (Cologuard©). For this at-home test, patients provide a stool sample using the special kit provided and mail it back to the lab. The sample is then examined for DNA and traces of blood associated with polyps and colorectal cancer. If results are suspicious, a follow-up colonoscopy will be required.
Immunochemical Test (FIT). Also an at-home test, this screening method examines the stool for blood and certain cancer markers. As with FIT-DNA, if results indicate there may be a problem, colonoscopy will be recommended as a follow-up.

At-home screening tests require a doctor’s order and are only recommended for people at average risk for colon cancer, not high risk. In addition, they are not recommended for patients with a previous history of polyps. Patients should talk to their doctor about their risk factors to determine which screening test is most appropriate for them.

When to Begin Screenings

In recent years, colorectal cancer has been on the rise in younger people. As a result, the American Cancer Society now recommends that adults at average risk should begin screenings at age 45.

People with a parent or sibling who had colon cancer are considered higher risk and should begin screenings at age 40 or sooner. Those with other risk factors such as personal history of polyps or rectal bleeding will be monitored with more frequent colonoscopies.