By Natan Schleider, M.D.
July 9th, 2019
Source: American Family Physician Vol. 100 No,1 July 1st, 2019 p.10-11
As I approach 50 years old, I am thinking about which colon cancer screening test is right for me.
I will likely go with the gold standard, screening colonoscopy. If you don’t know what this is, the patient is put to sleep under mild anesthesia which is quite safe and a fiberoptic tube is placed up the anus all the way through the large intestine to look for colon cancers or precancers which appear as polyps. Pros of screening colonoscopy: you need it only every 10 years (5 if you are high risk or more often if you have colon cancer or have been treated for colon cancer); the procedure only takes about 20 minutes and you are home same day. Cons or the biggest complaint I hear is being up all night with diarrhea as patients are given a strong laxative to flush out their colon (aka large intestine) which allows the doctors to see the lining of the intestine without stool being stuck to the walls.
Screening colonoscopy is my choice because while there are many of good noninvasive tests which I will review below, if they are negative, reassuring; but if positive, you will need a colonoscopy anyway to confirm whether it is a true or false positive.
Other screening tests for colon cancer:
- Stool testing for blood also called Fecal Immunotherapy Testing (catches about 58% to 72 % of colon cancers). This is a cheap easy option an with a 97 percent specificity (meaning if the test is negative, you probably do not have colon cancer) this is a nice easy choice.
- mSEPT9 Blood Test (Epipro Colon) detects 73 percent of colon cancers with a specificity of 82 percent. This may be a nice option if you are not inclined to sending your poop to a lab, understandable.
- Cologuard is a stool DNA test where you ship your poop to a lab where the examine it for colon cancer risk. This can be done every 3 years and I like this alternative option.
- Computed tomography colonography means no invasive testing but you will still need to have your intestines cleaned meaning you’re up all night with diarrhea but at least this is not invasive.
- Flexible sigmoidoscopy is like a mini colonoscopy which while still approved, is hardly done anymore as it only looks at the first part of the colon potentially missing cancers in the middle or distal colon.
If you opt against colonoscopy, you can do some or all of the noninvasive tests. Any testing is better than no testing and unlike most cancers in the 21st Century, colon cancer is one we can catch and treat early. Go get tested!
Thanks for reading!
Natan Schleider, M.D.