Yes, it's still colon cancer awareness month, the month when all those medical types bug you about getting the dreaded colonoscopy if you're over 50.

None of them will try to sell the procedure as a replacement for a month in Hawaii. But they make a pretty good argument when balancing it against the alternative: the even more-dreaded colon cancer.

"It's the No. 2 cancer killer in America, and the crime about it is that it's totally preventable," Dr. Mark H. Johnston, of Lancaster Gastroenterology Inc., said.

Johnston gave a short roster of "pearls" about colonoscopies, a procedure in which a thin tube with a camera on the end is inserted into the rectum to examine the lining of the large intestine.

Most of us might not think there are pearls or any other precious gems associated with a colonoscopy, but for Johnston, a guy who does these all day long, there are some real pluses to the unpleasant procedure that can save your life.

For one thing, a doctor may find cancerous polyps during your colonoscopy, but by the time you wake from the anesthesia, they're already removed. Other cancer screenings can detect signs of suspected cancer, but later procedures are required to remove cancerous cells.

And for those with no family history of colon cancer and of average risk, colonoscopies are necessary only once every 10 years. Many other cancer screenings must be done every year.

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Colonoscopies have been around since the 1970s. But what really made them accessible was when Medicare began covering the procedure.

"That changed everything," Johnston said. "The data that proved it worked only emerged in the 1980s or 1990s. Then it got approved (for Medicare coverage) sometime in early 2000. A lot of people used to say, 'If it's not paid for, I'm not doing it. But if the government pays for it, OK, I'll do it.' "

So it's most likely covered by Medicare and private health insurance, and it works. But those who've had colonoscopies relentlessly complain about the night-before prep, which usually requires drinking some fluid that tastes awful to clean out the colon.

"You'd be lying if you said the prep is a piece of cake," Johnston said. "You used to have to drink a gallon of the stuff that tasted terrible and made you nauseated, but none of us use that anymore. The preps are significantly better than they were 10 years ago."

Although there are about 20 preps on the market, the one your doctor prescribes depends on other health conditions, which can be aggravated by some of the preps. Now, most often, Johnston recommends a prep that's similar to Gatorade. Some patients still don't like it, but Johnston said many say it's not a big deal.

And while colonoscopies used to be painful and uncomfortable, many practices now use heavier anesthesia, so patients sleep through the procedure and awake pain-free.

"You feel nothing. It's a much, much more tolerated procedure now," Johnston said.

The downside to colonoscopies, other than the procedure itself, is that patients still will need someone to drive them to and from the doctor's office. And even this routine procedure can have complications: a 1 percent chance of bleeding and a less than 1 percent chance the intestinal lining will be perforated.

"Even with no family history of colon cancer, you have an average risk of 6 percent chance of getting colon cancer," Johnston said. "So you have six times greater chance of getting colon cancer than bleeding from a colonoscopy. And you have a less than 1 percent chance of having a perforation during the procedure, so you have a much greater risk of getting colon cancer than you do of even one of the mildest complications. Everything we do in medicine is always risk versus benefit."

Another pearl Johnston offers is this: "One of the greatest proofs in the pudding is whether doctors believe in what they're doing. Every one of us in our practice who's 50 and over has had a colonoscopy," Johnston said. "That tells you something. Doctors are kind of bad patients who tend to say, 'Do what I say, not what I do.' But when it comes to this screening, we all have this done. And it's because we've seen so many people's lives saved from colon cancer."

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If nothing else, a colonoscopy will buy you a day off work, but it might just save your life, too.

"Colon cancer fatality rates are going down because we're picking it up earlier in these screenings," Johnston said. "If you catch it earlier, it's much more treatable than if you catch it later."

If you want to know what a colonoscopy is all about, go to youtube.com/watch?v=LpaEWpYUdDQ. There may be funnier YouTube offerings, but this one shows what happens during a colonoscopy and what your doctor will see through the colonoscope. It also shows examples of abnormalities in the colon.

E-mail: slindt@lnpnews.com