Elder millennials, brace for your colonoscopies

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Butts. Everybody’s got one. Form meets function in the powerhouse of our lean, mean sitting machine.

And yet, far too often, our butt does us dirty.

The American Cancer Society estimates that more than 107,000 Americans will be diagnosed with colon cancer this year, in addition to almost 47,000 diagnosed with rectal cancer. Colon cancer is the second most common cause of cancer deaths in the United States. While rates have decreased in older adults because of early screening, they’ve increased among younger adults in recent years. With March being National Colorectal Cancer Awareness Month, now is a good time for a public reminder that doctors now recommend colon cancer screenings beginning at age 45.

You know, the age I just turned last year. The same age that the millennial generation turns this year. Colonoscopies now apply to contemporaries of Justin Timberlake. Indeed, “Rock Your Body” takes on a whole new meaning.

Our family nurse practitioner suggested a colonoscopy at my last physical. There were other options. Speaking as politely as possible, I could have performed my daily constitutional into a box before sending it to a lab.

Some of my relatives chose this option, including one who asked me to bring their box to the UPS shipping center in Hibbing, Minn. This happens to be located in a boutique gift store. There I stood in line holding the clearly marked Cologuard box alongside shoppers eyeing crystal babies and potpourri jars. I wanted to tell them that the box wasn’t mine, but I think that would have made it worse.

That’s why, when the Angel of Depth visited me last month, I opted for the full colonoscopy. If something was wrong, I’d know right away. If everything checked out, I’d get a 10-year reprieve from further screenings. No need to involve the nice ladies at the gift shop.

People provide lots of advice about your first colonoscopy, much of it unhelpful. If you don’t like puns or scatological humor, there will be dark days ahead. But I want to help you. Dare I say, it is my duty.

Here we have a medical procedure that famously involves running five feet of high-end video cable through the business end of your large intestine, but the least objectionable part is when that actually occurs. In fact, thanks to the sedatives, you’ll be glad when it does. What a relief!

The hard part is the liquid diet and aggressive laxatives that precede colonoscopy. The treatment I was prescribed required chugging from a gallon jug of liquid best described as seawater-flavored Gatorade. Though fundamentally a biochemical reaction, the ensuing event felt like the sudden onset of global war.

And, as King George VI once warned, “War can no longer be confined to the battlefield.”

Here are a few tips.

Much like a real war, the guiding principle is to stay alert. Perhaps your belly gurgles on a normal day, but today this sound is a critical piece of reconnaissance. Take to the hills, and quickly.

You will spend considerable time in your bathroom. Let your family know that they should clear out of there maybe a day or so. Now is a good time to finish that Melville tome or catch up on your favorite games. It is not a good time to take a video call or do squats.

You might hear “liquid diet” and figure you’ll be hungry. Well, it’s true, you’ll be a little hungry. And you might further hear that you can eat gelatin and expect you’ll need lots and lots of it. Trust me, once things get rolling, you just need the regular amount of Jell-O.

Fortunately, it’s a routine procedure and the people at your clinic or hospital have a lot of experience. Complications are rare and outcomes are very good. If something is wrong, chances are your doctor can fix it right there. If something is really wrong, you’ll be able to pursue lifesaving treatment with much higher odds of success. And, most likely, nothing is wrong.

That’s the news I got. I won’t need another screening for at least 10 years. I even got a nice thank-you card from all the people on my care team who definitely saw some things.

Best practices for colonoscopies continue to evolve. A 2024 Harvard University study published in JAMA Oncology suggests that a negative screening at a young age might safely buy some patients more than 10 years.

One idea has broad agreement, however: an initial screening significantly reduces your risk of one of the deadliest forms of cancer. According to a 2022 study in the New England Journal of Medicine, colonoscopies are the most effective screening tool. That means, for the generation about to turn 45, bottoms up. Figuratively speaking, of course.

Perhaps after millennials begin podcasting about their first colonoscopies, baby boomers will begrudgingly admit that the kids are alright, or at least that they aren’t kids anymore.