Our Breast, Cervical and Colon Health Program (BCCHP), helped more than 600 people get colorectal cancer screenings last year. Most had negative results, but a few needed additional screening colonoscopies. Cristina Del Alma, our colorectal cancer screening and cancer treatment coordinator helped these clients through their colonoscopies.  She knows that colonoscopies aren’t fun, but she’s passionate about her job and wants to do what she can to demystify the process. We sat down with her to learn more and begged her to be as forthcoming as possible. Our hope is that if we take the mystery out of these cancer screens, you’ll feel slightly better about getting them done.

What’s the purpose of a colonoscopy?
A colonoscopy is the process that is used to screen for colorectal cancers. Gastroenterologists use an endoscope (a long, thin, flexible, lighted tube) fitted with a tiny camera to look for polyps, little clumps of cells that form on the lining of the colon. And the end of the camera is a hook used to remove polyps.  A polyp can turn into cancer, but if found early, before they turn into cancer, they can be easily removed during a colonoscopy.

You’re sticking a camera where? How much is that going to hurt?
It’s not really painful – just a little awkward and uncomfortable. You will be given a medicine through an IV that puts you in a light sleep called “conscious sedation.” A health care provider will then examine your colon for polyps and remove them, if any are found, during the procedure. From when you arrive at the provider’s office to when you are fully awake after the procedure should be about 2 hours.

The key is to follow a few important steps beforehand so that the screening can be done properly.

Tell me more about what I have to do before getting a colonoscopy.
In order for the screening to work, the colon has to be “scrubbed” clean. To make this happen, you’ll have to avoid certain foods (essentially follow a low fiber diet for about 3-7 days before the screening), drink only clear liquids, and take a strong laxative (about a gallon of a thick, salty, “not the best tasting in the world” drink), that will be prescribed by your health care provider, leading up to the colonoscopy. Honestly, this is probably the hardest part of the whole ordeal.

Here are some tips I give clients:

• For clear liquids only drink a liquid if you can read a newspaper through the bottom of your glass.
• Chill the laxative several hours before drinking to help make it easier to drink.
• Drink the laxative a little at a time. This may make it easier to drink.
• Use a straw to drink the laxative. This may make it easier to drink.
• Don’t mix the laxative with your favorite flavor because it may not be your favorite afterwards!
• Flavor the laxative a glass at a time-you may want to switch flavors.
• Don’t drink or eat items that are red or purple.  The residues of these in the colon can look like blood.
• Drink lots of clear liquids to avoid dehydration.
• Stay close to a bathroom. The laxative works quickly.
• Use soft toilet paper and moist wipes to keep comfortable.
• Use hemorrhoid cream to protect your skin.
• Ask questions to help you feel more comfortable. For topics that are uncomfortable for you, write out your questions and hand them to your health care provider.

What if my healthcare provider finds a polyp?
If your health care provider finds a polyp, most can be completely removed during the colonoscopy.

What happens after it’s done?
Celebrate with a good meal. You will be hungry!

Who should get a colonoscopy and how often should it happen?
Starting at age 50, get screened once a year. Have a stool test, either a fecal immunochemical test (FIT) or fecal occult blood test (FOBT). These tests look for signs of cancer by testing for blood in your stool.

If the stool test is positive, you will need to have a colonoscopy. Most providers will suggest you have a colonoscopy every 10 years, even if you did not have a positive stool test.

Your provider may suggest that you get a flexible sigmoidoscopy every five years. This test looks for polyps in your colon using a shorter tube than a colonoscopy. If polyps are found during this test, you need to have a colonoscopy to remove them.

Some people may be at an increased risk of developing colon cancer because of family history or other factors. Those at an increased risk should talk to their health care provider about when to begin screening, which screening test is right for them, and how often to get screened.

Besides the obvious, why do you think people avoid this screening? How can folks get help?
Cost, time, and language barriers are often obstacles to screening, but we can help.

People who are below the 250% of the federal poverty level, who do not qualify for Washington Apple Health, and who have no insurance through their employers are often left without coverage and high health care bills. As a result, people often don’t seek common preventive medical services such as cancer screenings. Our staff provides free screenings for this vulnerable group of people.

Additionally, not having paid sick days, and the cost and availability of transportation also creates obstacles for many of our clients. I often assist clients with deciphering bus routes, scheduling cab rides and covering the cost of transportation so clients can get to their screening appointment.

Finally, many of our clients are immigrants and may not speak English. It can be extremely difficult to navigate an unfamiliar medical environment, let alone in a language that may be unfamiliar to you. I work with our clients to provide them with interpreters if needed. We also partner with clinics and providers who have the ability to help our clients who speak languages other than English.

What is Public Health’s role?
Besides what I just mentioned, our Breast, Cervical and Colon Health Program helps eligible people get free cancer screenings. Last year, more than 600 men and women were screened for colon cancer through this service. Clients are often referred to us through their primary care provider and can reach out to us directly by calling the Community Health Access Program line at 1-800-756-5437. Then someone on our team helps schedule the colonoscopy, explain the process, and even find transportation to their appointment if needed. BCCHP also helps eligible people get free screenings for breast and cervical cancer (BCCHP helped over 2,700 women get screened for breast and cervical cancer last year), and helps those who have a breast or cervical cancer diagnosis navigate the application process for Medicaid coverage for their treatment, and any issues they may have related to their benefits, medical bills, and annual enrollment.

Who is eligible for free screenings with BCCHP?
You may be eligible for a free health exam and cancer screening if you:

• are age 40 to 64 or before 40 if you have a family history
• have a low income
• live in King, Kitsap, Clallam, or Jefferson Counties
• don’t have health insurance
• don’t qualify for Washington Apple Health insurance or Medicare
• have a high deductible for follow-up cancer tests

To get more information and to see if you qualify for a free screening, call the Community Health Access Program line at 1-800-756-5437.

To find out more on when and how often to get screened check out BCCHP’s website and information from the Centers for Disease Control and Prevention on screening recommendations:

Breast cancer screening: https://www.cdc.gov/cancer/breast/basic_info/screening.htm

Cervical cancer screening: https://www.cdc.gov/cancer/cervical/basic_info/screening.htm

Colon cancer screening:  https://www.cdc.gov/cancer/colorectal/basic_info/screening/index.htm

Originally posted on October18, 2017.