Baring all: Amherst woman undergoes public colonoscopy to promote cancer awareness
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When Anna-Beth Winograd of Amherst arrived at Cooley Dickinson Hospital last month for a colonoscopy, she was having a procedure that about 8,000 patients a year undergo at the Northampton hospital.
Winograd was, however, the only patient to show up for the cancer screening test with a camera crew and television reporter in tow.
A story about her colonoscopy, complete with inside views of her colon, aired a couple of days later on WGGB-TV, ABC Channel 40 in Springfield and is still posted at www.wggb.com. Dr. David A. Berkman, who did Winograd's colonoscopy, was interviewed for the TV piece as well.
Winograd, 46, made her decision to go public because her brother, Michael, died of colon cancer 12 years ago at age 55.
"I miss him all the time," Winograd told anchor Elizabeth Corridan on camera.
Doctors had said, according to Winograd, that if he'd had a routine colonoscopy at 50, the age at which the American Cancer Society recommends most people undergo their first one, Michael Winograd would likely still be alive.
Winograd is the community relations director at Cancer Connection in Florence, a private nonprofit organization that offers programs and services for people living with cancer and their families. Several years ago, she was featured in a series of print advertisements prepared by Cooley Dickinson Hospital to promote colon cancer screening. Earlier this year, Winograd told the CDH marketing department that she would be willing to do more if they needed her. Christina Trinchero, the hospital's spokesperson, asked if she'd consider being the subject of a television story about getting a colonoscopy.
Winograd said she was game.
In memory of her brother, she had vowed to do "whatever it takes," Winograd said, to encourage others to undergo the screening procedure.
Putting it off
In a talk he gave last week at Cooley Dickinson, Dr. Jeffery Cooley, a gastroenterologist, said that statistics show that many people still need to be persuaded to be tested. Only about 47 percent of all Americans over 50 currently get any kind of colon cancer screening, he said, and the rates are somewhat lower for racial and ethnic minorities and for women. More men get screened for prostate cancer, he said, than for colon cancer.
Fear and embarrassment are two of the reasons that many people put the test off, Cooley said. That's especially regrettable, he said, given that "early detection can save lives."
During a colonoscopy, a lighted instrument with a camera at its tip is inserted and moved through the intestine, displaying pictures on a monitor screen. The procedure, performed under light sedation, allows doctors to see inside the entire length of the colon and rectum and to remove growths called polyps before they turn into cancer.
Though there are other screening methods available, Cooley, who practices with Dr. Berkman and three other physicians at Hampshire Gastroenterology Associates in Florence, said he and his colleagues still consider colonoscopy the best, most effective test. For example, the fecal occult blood test, in which stool samples are examined in a lab for the presence of blood, is useful, but can produce false positives and false negatives, Cooley said. Another test, called sigmoidoscopy, can only examine one-third to one-half of the colon. "It's like doing a mammogram of the left breast every year," he said.
Even with its clear advantages, colonoscopy isn't perfect, Cooley said. Some patients experience discomfort and removal of a polyp can cause bleeding. The most serious complication - a hole or tear in the colon wall - is rare, he said, but can happen.
Beyond that, a 2008 report about flat growths in the colon raised new concerns. The study in the Journal of the American Medical Association found that these hard-to-see growths are both more common and more likely to be cancerous than had been thought. Unlike knobby, protruding polyps, the flat growths can blend into the colon wall. The report said doctors who tend to perform colonoscopies quickly should slow down and look carefully. The message now, Cooley said is: Don't rush.
Unknown cause
Colon cancer is the second-leading cause of cancer deaths, after lung cancer, in the United States, Cooley said. The American Cancer Society estimates that about 150,000 Americans are diagnosed with colorectal cancer every year, and about 55,000 people annually die from it. It strikes men and women in about equal numbers, Cooley said; one in 18 Americans will be diagnosed with it. African-Americans have a 16 percent higher incidence of the disease, he said, leading many doctors now to encourage screening for that population beginning at age 45. "That's still not widely enough known," he said.
The commonly listed symptoms of colon cancer include changes in bowel habits, bleeding and abdominal discomfort. But not every patient with the disease has symptoms, Cooley said, which is why screening is so important. Within the last two weeks, Cooley said he'd had two patients, both 50-year-old women, who had no symptoms, no warning signs, but were found to have cancer.
In his talk, Cooley went on to discuss the risk factors for colon cancer, described one recent change in the way patients prepare for a colonoscopy, summarized what is known - and still unknown - about the disease, discussed the benefits and downsides of various types of colon cancer tests, and talked about the tests that may replace colonoscopies in the future.
The biggest risk factor for colon cancer is age, Cooley said: 90 percent of colon cancer cases occur in people over 50. Other risk factors include a history of ulcerative colitis or Crohn's disease; a family history of colon cancer, which accounts for about 15 percent of colon cancer cases; a high-fat diet; being overweight; a sedentary lifestyle; and alcohol and tobacco use.
Cooley pointed out, however, that there isn't always hard and fast data to draw specific guidelines about those associations. Exactly how much alcohol is OK and how much is a risk factor, for example, isn't known, he said. Similarly, there are still unanswered questions about diet. Recent research suggests a link between char-broiled beef and colon cancer - something you might want to bring up at one of those upcoming summer cookouts, he said, drawing a laugh. "That data seems to be solid," he said, "as much as anything we have." Fiber, once thought to help prevent colon cancer, now appears to play no role one way or the other, Cooley said, nor do calcium or folic acid, once touted as possible preventatives. Researchers continue to look at whether aspirin or Vitamin D may help, Cooley said.
The exact cause of colon cancer remains unknown. What is known, he said, is that a series of genetic mutations occur that turn a normal area within the colon into a precancerous polyp, then into a cancerous polyp, and then, in some cases, into a cancer that can spread throughout the body. But exactly what initiates that process and why isn't clear, he said.
Only a small percentage of polyps wind up becoming cancerous, Cooley said, but it's not possible to tell by looking at them which ones will, and which won't. "That's why we like to remove them when we see them," he said - which is what happens during a colonoscopy.
Prep work
Prior to a colonoscopy, patients must avoid certain foods in the days immediately preceding the test; consume only clear liquids the day before; and empty the colon by using a laxative. It's crucial that the colon be as "clean" as possible, Cooley said: "If I can't see, I can miss polyps." In some instances, he said, he has had to tell patients that they should repeat the procedure in a year or two instead of the usual 10 years for a patient who has been given a clean bill of health. "And nobody wants that."
One recent change is that a widely used type of laxative preparation, which came in a small dose, was taken off the market, Cooley said, after it was linked to kidney and heart problems. Among the preparations still used is one that requires a patient drink a half-gallon of a laxative solution at two different times the night before the test.
Cooley said the day will come - perhaps within 10 to 15 years - when colonoscopies won't be the gold-standard screening test they are today. Though it is not yet quite ready for what he called "prime time," Cooley said there is a noninvasive test in the works that will likely be the test of the future. It involves lab testing of stool samples to look for the presence of abnormal DNA shed by a mutated polyp that could indicate colon cancer. "I think this will come to pass," he said, "and it would be a very good thing."
The so-called "virtual" colonoscopy - a less invasive test that uses X-ray equipment to produce detailed computer-generated images of the colon - is being done in some places, but has its downsides, Cooley said. The software for it is expensive, he said, the test is time-consuming, and it can turn up minute "spots" in other parts of the body, such as the lung or liver, that probably aren't anything to worry about, but will prompt further tests.
For now, Cooley said, he would urge anyone over 50 or with other risk factors to talk to his primary care doctor about getting a colonoscopy. Once the referral is made, most patients who go through Hampshire Gastroenterology Associates will need only to speak by phone with someone from that office to make the arrangements; the waiting time for most patients who will have the procedure at Cooley Dickinson Hospital is four to eight weeks.
Anna-Beth Winograd got a clean bill of health after her colonoscopy. Berkman was great and nurse Penny Mitchell, she said, had provided "wonderful, upbeat and positive" support throughout. Because of her family history, she'll come back for her next one in five years, she said.
Meanwhile, the response to the piece that aired on television has been gratifying, she said. Many people have approached her here and there to thank her for making her story public and for showing that the test isn't, as she puts it, "a big deal.
"Sure the 'prep' is inconvenient, but it's a whole lot less inconvenient than surgery, radiation and chemotherapy."
One friend, a woman in her 50s, had emailed Winograd after hearing of her plans to do the TV story. Amazed that Winograd was going to go public, the friend confessed that she knew she, too, should get tested but the whole idea of a colonoscopy had been stressing her out. After the story aired, Winograd heard from her a second time.
"You made it look so low key," her friend wrote, "that you've convinced me to stop dragging my heels on this" and make the appointment.
"I was thrilled," Winograd said.
Suzanne Wilson can be reached at swilson@gazettenet.com.
