So you have agreed to colon cancer screening. That’s great! Now, what are your options? Do you really have to have a colonoscopy?
It depends.
Make no mistake — a colonoscopy is the best method of screening for colon cancer. It the least likely to miss a cancer and offers the longest recommended time between screening methods. If you have no polyps and no close family history of colon cancer, it’s 10 years before you have to undergo another screening.
If you cannot or will not undergo a colonoscopy, another option is a compute tomography (CT) colonography (or virtual colonoscopy). This method uses low dose radiation to visualize along the length of your colon for any polyps. Although it doesn’t require sedation and is as accurate as a colonoscopy at identifying polyps, if a concerning polyp is found, you then must undergo a regular colonoscopy to biopsy it. This adds to your overall cost. Also, both tests require the same bowel preparation procedure, and the CT colonography has a window of only five years to the next screening.
Other screening options include the flexible sigmoidoscopy or air contract barium enema. One test is a mini colonoscopy done directly in the doctor’s office without benefit of anesthesia (though you still must do the prep). Although less expensive, this test is rarely done anymore and only buys you three-five years before the next recommended screening since the test only visualizes the last part of the colon. The air contract barium enema is also rare due to limitations of the number of cancers it finds.
A less invasive test that can be done on people with very low risk levels for colon cancer is Cologuard® or FIT-DNA testing. These are two tests that look for traces of DNA associated with colon cancer. A negative test result is good for three years but only picks up 70-92% of colon cancers and only 40% of precancerous polyps. The low capture rate means a cancer could be missed, but it’s certainly better than not getting screened at all. Cologuard and Fit-DNA cost about half what a screening colonoscopy costs but a positive test will still mean that a colonoscopy needs to be done.
The final method of colon cancer screening is a yearly test for fecal occult blood (looking for hidden traces of blood in the stool) either at your doctor’s office or with stool testing cards that the office sends home with you. This method is extremely inexpensive, but misses a lot of polyps and early cancers. It is better than nothing, but not ideal.
Be sure to discuss your screening options with your doctor to find the one that’s best for you. Your colon will thank you.
Dr. Beth Hodges is a family practice and palliative care/hospice physician in Asheboro, N.C., as well as a part-time medical director for HealthTeam Advantage.
