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Dreading a Colonoscopy? There Are Other Options

Your doctor can help you determine the best colon cancer screening for you


Bill Dressler, 54, had no history of colorectal cancer in his family, but when he turned 50, he knew screening was recommended and he planned to get it done. Then, he made a cross-country move from Kansas City, Mo., to Port St. John, Fla., and things like age-appropriate medical screenings were pushed to the back burner.

It wasn’t until he was 52 and a high school friend posted on Facebook urging others to get screened for colorectal cancer that Dressler did so. He had no symptoms and no major health issues, but his doctor still recommended a colonoscopy.

During that procedure, Dressler’s doctor discovered a sessile serrated polyp — a large, flat polyp — on the right side of his colon. These types of polyps must be removed in a subsequent colonoscopy using a procedure that lifts the polyp so it can be cut out. In some cases, the only way to remove them is through colon resection surgery.

Dressler was referred to a specialist at the Mayo Clinic in Jacksonville, Fla., and had a good outcome. The polyp, found to be pre-cancerous, was removed using the non-surgical technique described above. The result of his one-year follow-up test was negative, and his next follow-up will not take place for another three years.

When It’s Time to Get Screened for Colon Cancer

Dressler’s story demonstrates that colorectal cancer screenings are important, although most people are not thrilled about the prospect of a colonoscopy.

According to the American Cancer Society, colorectal cancer is the third leading cause of death among men and women in the United States. The good news is that over the last several decades, early detection, polyp removal and colorectal cancer treatment have significantly reduced death rates.

It is recommended that people age 50 and older have some sort of colorectal cancer screening (some organizations are now saying age 45, so discuss your risks with your physician). If your first test is negative, your doctor will likely recommend another test in 10 years. If a pre-cancerous polyp is found, your follow-up will likely be in one to three years.

Colorectal Cancer Screening Options

There are several screening tests available, depending on your health status and colorectal cancer risk. It’s important to discuss the options with your doctor as you consider which to choose. Here are four of the most common tests:

1. Colonoscopy. This is the most well-known and widely used option. It is also the most dreaded due to a preparation at least one day prior requiring the patient to drink a solution that cleans the colon. It is also the most invasive of the procedures.

Patients may be advised to go on a low-residue diet for up to three days before a colonoscopy and a liquid diet one day prior to the procedure. They also must drink the colon-cleaning solution the night before, and if the procedure is in the early morning, the best preps include getting up in the middle of the night to drink even more solution.

In the U.S., patients are typically sedated for colonscopies. A tube with a tiny video camera at the tip is inserted into the colon to allow the physician to check for polyps and signs of cancer. There is a slight risk of colon perforation and some risk with anesthetic.

Dr. Douglas Rex, a professor and director of endoscopy at Indiana University Hospital in Indianapolis, says those risks are very low, especially given the risk of developing colorectal cancer and the likelihood of survival if caught early.

Colonoscopies can detect more than any other test and are more reliable in finding sessile serrated polyps and traditional serrated adenomas, like the one found in Dressler.

“This is really the best test for detection for pre-cancer and cancerous polyps,” Rex says. “It is done with sedation, so there is little to no discomfort.”

Rex says if you are healthy enough for any type of surgery and don’t have a terminal illness, your doctor will likely clear you for a colonoscopy.

He adds that preparations with sodium phosphates once caused worry about possible kidney damage, but those have largely been pulled off the shelves. “At the present time, all of the common preps in use have no residual risks,” he says.

2. Fecal immunochemical test (FIT). This test screens for the presence of blood, as many cancerous polyps bleed, secreting blood into fecal matter.

The advantages of the FIT test are that it requires no preparation or sedation and may be an option for people not healthy enough to undergo a colonoscopy or other surgery.

A disadvantage is that if something is detected, you will be referred for a colonoscopy, Rex says.

3. FIT/DNA test. This test is marketed in the United States under the brand name Cologuard. It combines a blood stool sample and looking for DNA markers detected in cancer. “It’s a very specific test gaining in popularity,” says Dr. Michael Wallace, professor of medicine at the Mayo Clinic in Jacksonville.

The benefit is the same as the FIT test in that it may be an option for people who cannot undergo a colonoscopy. It’s also an option for people unwilling to have a colonoscopy. Many people prefer it because they don’t have to go to a clinic or hospital; they just collect a stool sample with a special kit in the comfort of their own bathrooms and send it by mail or other delivery business.

There are two chief disadvantages to the FIT/DNA test. One, like the other FIT test, if your results are positive (abnormal), you will be referred for a colonoscopy. Also, this test has a 12 percent false positive rate, and that rate continues to climb for people 60 and over, Rex says.

4. CT scan or “virtual colonoscopy.” While this has gained some press recently, it is still not used widely, Rex says. It is less invasive than a traditional colonoscopy but it requires inflation of the colon, which can be uncomfortable.

Rex says it is not covered by many insurance plans, and requires a follow-up colonoscopy if something suspicious is detected during the procedure.

Costs of Screening Options

Colonoscopies are covered 100 percent by insurance, as mandated by the Affordable Care Act. The other types of tests could require insurance co-pays and apply to deductibles because some insurers consider them to be diagnostic tests rather than screenings, according to the American Cancer Society. This is because if the result of these other tests is positive, the patient will need to have a colonoscopy.

By Kerri Fivecoat-Campbell
Kerri Fivecoat-Campbell is a freelance writer whose work has appeared on Forbes.com, AOL.com, Mainstreet.com, Creditcards.com, Bankrate.com and elsewhere.

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