“But who is going to see these family members, and who is going to do these colonoscopies?” – Dr.Babe Gaolebale
This week I saw a young man in his early 30’s who was diagnosed and treated with colon cancer. He got surgery to remove the cancer, and afterward he got chemotherapy to kill any remaining cancer cells in his body. He finished the chemotherapy at the end of 2014. When he came to see me, he was gave me a copy of his CT scan which showed a narrowing of his colon preventing him from passing stool. As I arranged for him to get a colonoscopy to take a look at this narrowing, to figure out whether the cancer had come back or whether there was some other problem, it struck me how young the patient was. I can’t remember ever seeing a colon cancer patient this young during my training in the United States. The average age for colon cancer diagnosis in the US is 72, and almost all diagnosed colon cancers occur in people who are greater than 50 years old. There is an inherited syndrome of colon cancer called familial adenomatous polyposis (FAP), which can cause people with a certain mutation to develop colon cancer at a very young age. I wondered if this patient had the mutation. There are other inherited syndromes which can be diagnosed with genetic testing, too, and I wished we could test this patient to figure out why he developed colon cancer at such a young age.
“Do you have any kids? Brothers or sisters?” I asked
“I have a son who is a small child, and I have many brothers and sisters.”
“Make sure that all your siblings get colonoscopies, and your son should start getting them as early as age 20,” I said immediately.
Dr.Babe Gaolebale, our palliative care specialist who had joined me in clinic, stopped me. “But where should we send these family members? Who will do these colonoscopies?” she asked.
I realized she was right. Unlike in the United States, Botswana has very few endoscopy machines, and very few doctors trained to do colonoscopies. Screening colonoscopies are virtually never done. It would be close to impossible to arrange for colonoscopies for his family members who had no symptoms; it’s difficult to get colonoscopies here even for patients with severe symptoms such as bleeding or abdominal pain. “I’ll talk to the surgeon and see what we can arrange,” I told the patient, but I had this gnawing feeling at the pit of my stomach that it might not be possible to do anything for them, and they could potentially suffer the same fate.
I’m often reminded how we take for granted all that we have available in the United States for healthcare. The widespread availability of colonoscopies is a lifesaver. I recently convinced my mother, who is in her early 70’s, to undergo her first colonoscopy (after begging her for years), and urge you or your relatives to do the same if they are older than 50. If only I could offer the same for my patients, friends, and coworkers in Botswana.