A 71-year-old woman contemplating a screening colonoscopy.

DR BURNS: Ms G is a 71-year-old woman with a past medical history of osteoporosis, mitral valve prolapse, mild rheumatoid arthritis, and hypothyroidism. She has Medicare. Ms G is trying to decide whether to undergo a colonoscopy to screen for colon cancer. Ms G is currently feeling well and has no active medical issues. Ms G’s physician has encouraged her to have a colonoscopy, but she remains reluctant to proceed for 3 reasons. First, she has had adverse reactions to anesthetic agents in the past and is concerned about a potential reaction to the agents that would be used for a colonoscopy. Second, she is concerned about needing transportation home after receiving a sedative because her husband has driving restrictions. Third, she is unsure about the importance of colonoscopy given her negative family history of colon cancer. In addition, she expressed a concern about the size of colonoscopes designed for adults. Of note, she has completed home-based fecal occult blood testing (FOBT) on a yearly to every-other-year basis, and test results have always been negative. She has never undergone flexible sigmoidoscopy. She has been screened for breast and cervical cancer. She has had bone densitometry and was found to have osteoporosis for which she currently takes alendronate as well as calcium and vitamin D. Ms G also has had cholesterol screening performed on a yearly basis. She is currently taking alendronate (70 mg weekly), calcium, vitamin D, and levothyroxine (75 μg daily) and reports vomiting as an adverse reaction to diazepam. She has undergone allergy testing, which revealed an allergy to epinephrine and all members of the “caine” family except carbocaine. She is married. She does not smoke and drinks red wine with dinner. She remains physically active around the home and in her garden and practices piano on a daily basis. Travel is restricted by her husband’s limited driving ability. MS G: HER VIEW I’ve had a lot of pressure from my doctor to have a colonoscopy, but I’m reluctant to have one for several reasons. First of all, you have to have some sort of a relaxant and I’m afraid to take one of those tranquilizer type things because I just react badly to that stuff. I talked to my doctor and she thought it might be possible to do it without sedation especially if they used pediatric equipment. Second, I could never have it done here. My husband is truly handicapped and cannot drive other than right around the house, so he could not drive me here and I’d have to have somebody else bring me down. The third thing is that my father is 1 of 9 children, my mother 1 of 5 and nobody has ever had colon cancer on either side of the family that we know. So those are my reasons. However, this summer it really hit me because my doctor said she thinks I should go ahead and have one because my health is so good, that I should, barring trucks hitting me, etc, last a long time, and that I should have the colonoscopy just in case there’s something lurking there. And I had never thought about it that way and I thought that was valid.