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Jackson: Old folks need colonoscopies too — tell the AMA

Jackson: Old folks need colonoscopies too — tell the AMA

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Thursday is my birthday, and as all of my friends can attest, birthdays are important to me. Starting in December, and on every subsequent 22nd of the month, I remind them of how many more months there are until my big day. When July arrives, the reminders increase.

It’s not that I’m trolling for gifts, but by reminding them of my birthday, we can plan excursions or lunches. I do admit, however, that I relish every phone call and card I receive. Sadly, one card will be missing from my mailbox this year due to the death of a friend, a loss not due to the coronavirus or gun violence, but to colon cancer. Accordingly, I’m now on a mission to encourage the American Medical Association to change its recommendation regarding seniors and colonoscopies.

Before actor Chadwick Boseman’s death from colon cancer in 2020, the American Medical Association recommended that screening colonoscopies for most Americans should start at age 50 — the exceptions being people with a family history of the disease or who have symptoms requiring earlier testing. After Boseman’s death at age 43, the association lowered the recommended start date to 45. However, the association did not change its recommendation regarding the end date for screenings — it’s still 75. Medicare and many private insurers follow these guidelines. With an ever-aging population, this no longer makes sense.

When the recommendations were originally made, life expectancy was shorter, so age 75 might have seemed reasonable, especially considering that most colon cancers discovered later in life grow more slowly. But, as someone with a family history of longevity, where almost every member on my maternal side reached age 100, I consider 75 middle age.

According to 2018 statistics by the Social Security Administration (which is the latest published data), there were approximately 68,000 centenarians receiving benefits. Now, depending on which source you check, there are between 80,000 and 90,000 centenarians in the United States today, although the coronavirus may have reduced that. By stopping colorectal screening at age 75, we could be condemning a large part of our population to a painful and unnecessary early death.

Years ago, my gastroenterologist explained the age-based issue before he performed a colonoscopy on my 80-year-old mother. He said that as we age, our skin and the walls of our internal organs become thinner, and the colon itself can twist, making invasive procedures more difficult and riskier. Three years ago, he informed me that he didn’t want to “traverse my windy, twisty colon” ever again unless it was absolutely necessary, because I had so many pouches that he couldn’t perform the colonoscopy he’d attempted. Instead, he sent me directly to Missouri Baptist Hospital for a virtual colonoscopy, a test that fills you up with air, followed by CT scans of the colon.

This procedure is so safe that my Aunt Mavis had the same test two weeks shy of her 100th birthday. Thankfully, we were both fine. After my virtual test, he explained that there are at least three completely non-invasive tests available that don’t require the dreaded preparations of a colonoscopy.

And therein lies my argument. At the very least, the American Medical Association needs to encourage screening with these alternative tests. Still, if doctors raised the end date to 85, Medicare and the other insurers would be more likely to cover them, and more lives could be saved.

Today’s seniors aren’t the seniors of earlier generations. Before the coronavirus isolated them, these were the people who delivered meals to the “elderly.” Well into their 80s, they ferried people to dialysis appointments and volunteered at almost every cultural institution and hospital we have, in all sorts of capacities. One friend picked up and delivered library books to shut-ins. Another cannot wait to book more cruises to explore foreign lands. Many have embraced learning and even teaching via Zoom, even if they needed help setting up their electronics.

The friend I lost was almost 85, but until colon cancer appeared last year, she was totally independent, enjoying an active life. She always sent me the most irreverent birthday cards, perfect for a loud guffaw. I’m really missing her card today.

Janet Y. Jackson is a Post-Dispatch columnist and Editorial Board member. Email: jjayone@msn.com

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