By Brian Clark, M.D.
Hallmark Health Medical Associates
Though colonoscopy is the gold standard of screening, there are alternative tests available.
Let’s face it: Some people will never get a colonoscopy. I could recite all the ways that colonoscopy protects you from colon cancer until I’m blue in the face, but for some, it won’t be convincing enough.
Thankfully there are other options available.
Colonoscopy is the gold standard for colon cancer screening, because it is clearly the most effective way to not only detect but also prevent colon cancer. Colonoscopy is aimed and designed to detect pre-cancerous polyps with the goal of actually removing these polyps before they can turn into cancer – this is how colonoscopy PREVENTS colon cancer. In fact, undergoing colonoscopy can lower the risk of dying from colon cancer by 50 percent to 70 percent!
We recommend that anyone over age 50 have a colonoscopy (and earlier if you have other risk factors for colon cancer). Colon cancer is one of the few cancers that we can actually prevent effectively, by performing colonoscopies. If my own mother asked me what she should do to prevent colon cancer, I would tell her to get a colonoscopy.
Before you rule out a colonoscopy, I recommend reading my earlier blog post about what happens during a colonoscopy. If you still won’t get a colonoscopy, I would urge you to consider an alternative screening method.
While none of the alternative methods will be as effective at identifying and preventing colon cancer, they’re a better alternative than doing nothing, and they can still lower your chance of dying from colon cancer.
Alternatives to colonoscopy
Alternative colon cancer screening methods include:
1. Virtual Colonoscopy
This test is essentially a CAT scan of the colon, designed to find large polyps and cancers. It is important to understand that this test does still require a bowel prep (medication to clean out the colon) to be taken before the test (similar to colonoscopy). If pre-cancerous polyps are found, they must then be removed by undergoing colonoscopy at another time. We will sometimes recommend this for patients who had a colonoscopy that we could not complete successfully; this happens in only around 1 percent of patients.
- Pros: Good at finding large polyps and colon cancer; sedation is not required.
- Cons: Not as effective as colonoscopy at detecting small pre-cancerous polyps; can be uncomfortable; still requires bowel prep treatment prior to the procedure; if polyps are found, another procedure (colonoscopy) is required to actually prevent the cancer.
2. Stool-based tests
OK, here’s the disclaimer about these alternative tests: Unlike a colonoscopy, these tests are not designed to prevent colon cancer. They are designed, however, to catch colon cancer early. When caught early, colon cancer is readily treatable and associated with excellent outcomes.
There are three kinds of stool-based tests, the fecal occult blood test (FOBT), the fecal immunochemical test (FIT), and the newly approved stool DNA test. In each, you collect your stool sample and send it to a lab, where it is analyzed for microscopic blood (or abnormal DNA) in the feces.
The biggest advantage to the stool-based tests is that you don’t have to drink the bowel prep treatment and endure diarrhea beforehand. You can do these tests in the comfort of your own home, and obviously you don’t need to be sedated. They also are less costly than a colonoscopy.
But here’s the rub: These stool-based tests are less effective than colonoscopy at identifying cancer. They also detect pre-cancerous polyps less than 50 percent of the time. That’s why, in order to benefit from these tests, you need to do them much more frequently (every year for most), compared to every 10 years if your colonoscopy is normal. Finally, if one of these alternative tests is positive, you will need to then have a colonoscopy so we can examine your colon and determine the best course of treatment.
Here’s how effective each stool-based test is:
- FOBT: Detects colon cancer about 50 to 80 percent of the time.
- FIT: Detects colon cancer about 70 to 90 percent of the time.
- Stool DNA test: Detects colon cancer about 92 percent of the time.
While these tests are good at finding cancer, if you really want to prevent cancer, colonoscopy is the best way to go.
Which test should I choose?
With all these options, how do you decide which test to undergo? If your goal is to prevent colon cancer, you really need to have a colonoscopy. If you choose an alternative, stool-based screening method and you have important pre-cancerous polyps, it’s really a flip of the coin (or worse) whether these polyps will be detected.
If, on the other hand, you still wish to avoid colonoscopy, but you do not want to die from colon cancer, then an alternative, stool-based testing method is certainly better than doing nothing. With any of the alternative screening methods, the goal will be to catch cancer early enough that we can treat it effectively. To achieve this, FIT and the new stool DNA test (when used regularly and as directed by your physician) are attractive options because you can do them in the comfort of your home.
Colon cancer is the third most common cancer, and the second most common cause of dying from cancer in the United States. None of these alternative measures will protect you from colon cancer as well as a colonoscopy would. But they are definitely a better alternative than doing nothing, and can still lower your chance of dying from this preventable disease.
To schedule a colonoscopy or to obtain an at-home test, schedule an appointment with Dr. Clark or call (855) 446-2362.