“We either die with colon cancer or from colon cancer. It’s largely our choice.”
– Dr. Peter Attia. Let those words sink in for a moment. In many ways, if detected early enough, almost nobody should die of colorectal cancer.
Why am I spending so much time and energy talking about colonoscopies when I’m not a doctor, and it’s kind of embarrassing to talk about? Well, exactly because I am not a doctor, and it's kind of embarrassing to talk about.
When I posted about my colonoscopy on Instagram, four people DM’d me saying they were contacting their physician about getting screened for colon cancer immediately (and two of them had histories of colorectal cancer in their family). That moved me in an oddly profound way. You see, of the top five deadliest cancers, colorectal cancer (CRC) is the second deadliest and also the easiest to detect and prevent.
So, let’s talk about it. Let’s normalize it. Let’s encourage our parents, our loved ones, our friends, and ourselves to get screened.
Value your Thrivespan and get screened for colon cancer
One of the core tenets of our Thrivespan is longevity–how healthy we are throughout our lives. I am not a perfectionist, and I’m often a bit lazy, so I am always looking for the easiest, most effective ways to extend our lives. One of the easiest, most straightforward longevity hacks may be simply getting a colonoscopy.
Quitting smoking is hard. Not eating sugar is hard. Cutting back on alcohol is hard. Exercising several days a week is hard. Getting a colonoscopy is one of the easiest things you can do for your longevity. You chug a laxative cocktail at home the night before, scroll social media while you sit on the toilet and clear your system of food and waste, go to the clinic the next day, put on a robe and slippers, and take a restful nap or numbed-out drug trip while the doctors do the rest. That’s it. It’s so easy!
But what makes it so important to do? Let’s dive into that.
A couple of years ago, a friend of mine died of colon cancer. He was a lively, gregarious, loving father in his 40s who died way too young. At his funeral, almost every eulogy and memory was about how much he loved barbeque, how he loved red meat, and how he was King of the Grill. It was as if someone had died of lung cancer and everyone celebrated how much he loved to smoke. I had never even thought about the correlation until this poignant, light-bulb moment. This is not a message to stay away from meat. This is a message to make sure you get screened for colon cancer, no matter what you eat, and definitely if you love barbeque (like I do).
Last year, my father-in-law died of colon cancer, also way too young, in his seventies. He was strong, lively, and seemingly healthy just a week before he died. However, he never got a colonoscopy to truly tell him what was going on inside. Sadly, his mother died of colon cancer decades before him. This is not a message to say you will die of colon cancer if it’s in your family. This is a message to make sure you get screened for colon cancer, no matter what your family history, and definitely if it runs in your family (like it does for my wife).
What makes both of these losses hurt even more is how preventable colorectal cancer (CRC) can be. The five deadliest cancers, in order, are lung, colorectal, pancreatic, breast, and liver. Of these top five, CRC is the only one we can directly see, and that’s the beauty of it. Unlike almost every other type of cancer that can’t be seen with the naked eye, colorectal cancer can be, so if we get screened and polyps (growths) are found in the early stages, it’s relatively straightforward (and potentially life-saving) to remove them.
Why colorectal cancer is so easy to detect and prevent
CRC is one of the few cancer screenings where you probably don’t mind that much if something is found–assuming you get screened early enough. CRCs begin as polyps, tiny growths in the lining of the colon. The vast majority of these polyps remain insignificant and harmless, never becoming cancerous. Some, however, are pre-cancerous and can become malignant polyps that invade the wall of the colon if not detected–that’s what the endoscopist is looking for.
The endoscopist views the colon wall through a video camera and searches for polyps. If found, the colonoscope has instruments that allow the endoscopist to remove the polyps and then examine them to determine if they are malignant or benign. Since a colonoscopy can both catch and remove polyps before they turn cancerous, catching CRC early means we can effectively eliminate it on the spot. Studies show that colonoscopies can detect more than 90% of early-stage colorectal cancers and can even prevent cancer by identifying and removing polyps before they become cancerous. This means that by simply getting a colonoscopy, we have a significantly higher chance of catching potential issues early and preventing the development of colorectal cancer altogether.
I hear colonoscopy prep is awful
“Is the prep awful?” That’s not the question. The question you should be asking is “Compared to what?” I would be hard-pressed to think of many things more awful than having to tell my wife and daughters I am dying of colon cancer because I didn’t want to sit on the toilet one night. Compared to that, the prep is a walk in the park. If a plumber is looking at the pipes under your house, those pipes are going to need to be cleaned. Same with your own GI pipes–you are just cleaning them out. More than anything, the prep process is weird, but things get less weird the more we talk about them and normalize them. I don’t particularly feel like talking about this subject, but I know firsthand how many people are scared of this part of the process. So, I am going to talk about it and tell you, it’s not the dreamiest way to spend the evening, but it’s totally fine and significantly better than the alternative. Please do it for yourself and the ones you love.
When should I get a colonoscopy?
I am not a doctor, so I am not the one to advise when a colonoscopy is right for you. Talk to your physician openly. Bring it up. Ask questions, especially If you have any family history, IBS, discomfort, or questions. Just ask and push a bit and get help with earlier screenings if it makes sense for you. Sometimes stool sample tests can be ordered earlier–work with your doctor and your insurance. In general, the American Cancer Society advises that regular screening should begin at age 45 for people at average risk, and sooner if an individual might be at higher risk (family or personal history of CRC or inflammatory bowel disease (IBS), hereditary syndromes like Lynch Syndrome, etc).
CRC is not just an older person’s concern. The majority of people (about 70%) who are diagnosed with CRC under the age of 50 do not have a family history or hereditary condition. Among individuals under 50, colorectal cancer rates have been increasing. In the last decade, the incidence of colorectal cancer among adults under 50 has risen by approximately 2% per year, and it's estimated that 1 in 10 new colorectal cancer diagnoses are in people younger than 50. Talk to your doctor, and see what makes sense for you.
Let’s all tell the world (or at least one other person)
Colorectal cancer is easy to detect and easy to prevent if caught early enough. And it’s an easy process. The anesthesiologist or nurse puts you to sleep or numbs you to the world, the endoscopist checks you out, and then you come to, most likely knowing you do not have colorectal cancer; and if you have polyps that are caught early enough, it is straightforward to remove them. The earlier we get screened, the more peace of mind we have that any polyps are noticed and removed before becoming cancerous.
Are there easier and more straightforward ways to hack longevity? Kind of. But also, not really. Nobody should die of colon cancer, and yet people close to us do all the time. Make sure your parents get screened. Make sure your friends get screened. Make sure you get screened. And when you do get screened, be obnoxious like me and tell everyone all about it.