Colorectal cancer is the second-deadliest form of cancer, after lung cancer, yet it’s generally preventable.

Many Canadians don’t know there is a test, a colonoscopy, that can detect the hidden disease in its early stages. Others have heard of the test, but want to avoid the preparation or fear having a long tube with a miniature camera inserted up their rear ends.

“If people don’t bring the test up with their doctors and their doctors don’t recommend it, they tend to think it’s not necessary,” says Dr. Linda Rabeneck, medical director of Ontario’s Colorectal Cancer Screening Initiative Foundation and regional vice president at Cancer Care Ontario in Toronto. “People have the misconception that if there’s nothing wrong with the way their bowels are functioning, they’re fine — and that may not be the case.”

This year, an estimated 21,500 Canadians — one in 15 — will be diagnosed with the disease. Of those, 8,900 will die. The incidence of the disease is increasing in Canada by roughly 2,000 cases a year, says Bunnie Schwartz, who founded the Toronto-based Colon Cancer Canada Foundation after both her sister and her husband died of the disease in their 40s. And a growing number of young people are contracting it, although colorectal cancer is most prevalent in people over the age of 60, which means the precursors to the disease are occurring when people are in their 50s.

“You can’t see or feel colorectal cancer, which is why the test is so important,” Schwartz says. “If caught early, it’s curable. Not enough doctors are suggesting the test to their patients.”

The colonoscopy is viewed by doctors as the most accurate screening test. Using a flexible tube with a tiny camera at its tip, the test allows the doctor to view any unusual growths along the entire three feet of colon as images are transmitted to a video screen. The procedure also allows for the removal of small growths or polyps at the same time, which can be sent for testing for signs of cancer.

Most patients are sedated for the 30- to 60-minute procedure, relaxing them, and many doze through it. There is a one in 1,000 risk of accidental perforation of the bowel, which would require immediate abdominal surgery.

The test requires a thorough bowel cleansing in advance, which involves a dose of laxatives and staying close to a toilet the day before the test. Some say the purging is the worst part. But, if the test indicates a healthy colon, the colonoscopy does not need to be repeated for 10 years, in most cases.

Other tests include a sigmoidoscopy, a less invasive test that involves no sedation, but shows only the lower part of the colon. There is also a fecal occult blood test, which involves taking a series of small stool samples over three days, placing them on a chemically treated card and sending them to a lab. This test may indicate polyps, as polyps periodically ooze blood. But blood in the stool could also be a result of hemorrhoids or anal fissures. So, this test is less reliable.

There is also a virtual colonoscopy, in which the doctor uses a CT scanner to produce detailed images of the colon’s interior. No sedation is required, but the cleansing process is the same as with the colonoscopy and, if polyps are discovered, a colonoscopy must then be performed to remove them.

“I just had a colonoscopy done, and the procedure was a breeze,” says Susan Gitajn, a resident of Toronto whose former husband recently died of colon cancer. “I slept through the whole thing. Fortunately, I had a good outcome. But I was definitely worried.”

Because demand for the procedure is increasing, you can expect to wait in line unless your life is in immediate danger. It’s best to obtain a referral to a gastroenterologist from your family doctor. The procedure can be done in the day-surgery section of a hospital or clinic.

Rabeneck is one of the driving forces behind Ontario’s ColonCancerCheck, a campaign introduced in 2007 to promote colorectal screening. The provincial program is the first of its kind in North America and is designed to increase awareness among physicians, pharmacists and the public. The campaign involves advertising and brochures, and uses slogans such as “Don’t die of embarrassment” and “Your bottom should be at the top of your priority list.”

@page_break@Manitoba, Alberta and Sas-kat-chewan have followed suit with similar programs, and Nova Scotia has one in the works.

If an immediate family member has developed colorectal cancer under the age of 60, it is recommended you have a colonoscopy every five years, beginning at age 40 or 10 years earlier than the age that the youngest family member was upon being diagnosed with a polyp or cancer. IE