8 Options for Colon Cancer Screeningby Sarah Ellis Health Writer
Colon cancer has one clear enemy—early detection. The five-year survival rate for early-stage colon cancer is over 90%, according to Daniel Albo, M.D., Ph.D., director of surgical oncology services at Georgia Cancer Center at Augusta University in Augusta, GA. Unfortunately, most symptoms don’t appear until the cancer is already advanced, so you don’t want to wait until you notice anything unusual. Regular screening is essential to catch—and if necessary, treat—colon cancer as soon as possible. The good news? You’ve got options.
“The colonoscopy is considered the gold standard, and that’s the one all other tests are compared to,” says Rachel Issaka, M.D., gastroenterologist at Seattle Cancer Care Alliance and assistant professor at the Fred Hutchinson Cancer Research Center and the University of Washington. If you are considered at high risk for colon cancer due to family history or a gastrointestinal condition like IBD, you should choose this option. It’s also a great option for anyone at average risk who wants a high-quality screening procedure (as long as it’s covered by your insurance and you’re okay with anesthesia).
How It Works
During a colonoscopy, the doctor inserts a flexible camera into your colon to look for any signs of abnormal growth. “What we’re looking for are polyps,” Dr. Issaka says. “These polyps are small growths that can become cancerous. We’re also looking for early-stage cancer.” Doctors can then quickly remove these growths before they get bigger. You will need to do bowel preparation—which means drinking fluid laxatives the day before to clean out your colon. Stock up on soft toilet paper and reading material. You’ll also need someone to drive you home from the procedure.
When to Start Screening
Ask your doctor when you should start getting regular screenings – this varies depending on your specific risk factors. Dr. Albo and Jeff Nelson, M.D., colorectal surgeon and surgical director of The Center for Inflammatory Bowel and Colorectal Diseases at Mercy Medical Center in Baltimore, Maryland, recommend people who aren’t high risk get colonoscopies every 10 years starting at age 45. If you have a family history, Dr. Albo says, you should get a colonoscopy at age 40 or 10 years younger than the age your youngest relative was diagnosed. IBD patients also need to start screenings early.
A Quick PSA
Before we dive into other options, it's important to understand that if you're considered at high risk for colon cancer, or if you are experiencing worrisome symptoms like bowel changes or abdominal pain, you need to get a colonoscopy. “When we’re talking about screening for average-risk people–meaning those who don’t have any symptoms like rectal bleeding, abdominal pain, changes in their bowels, or unexplained weight loss–those people can use those other screening tests that are available,” Dr. Issaka explains. Let’s break those down next.
Fecal Immunochemical Test (FIT)
The FIT test is a stool sample test you complete at home and mail back. “What the fecal immunochemical test is doing is detecting small amounts of blood in the stool,” Dr. Issaka says. It’s non-invasive and fairly inexpensive (around $25) and needs to be completed once per year. The downside? It's not quite as accurate as a colonoscopy. “The FIT test is not the best test to detect really small polyps that can be seen and removed on a colonoscopy,” she notes. Plus, if your result is abnormal, you’ll need to schedule a colonoscopy regardless.
FIT DNA Test (Cologuard)
You’ve probably seen Cologuard advertised on TV. Just like the regular FIT test, it’s a stool sample kit delivered to your door. This test can detect genetic alterations that may indicate cancer or cancer risk. “It is trying to pick up on those DNA alterations, added together with the blood it might see in the stool, to give individuals an answer as to whether or not they need to have a more invasive test like the colonoscopy,” Dr. Issaka says. It’s more expensive than the FIT (around $450) and needs to be completed every three years.
The CT colonography, also called a virtual colonoscopy, involves the use of a CT scan to look for polyps in the colon. It also requires a bowel prep but no anesthesia. “It’s very good at finding tumors but not as good at finding small tumors and polyps,” Dr. Albo says. Dr. Issaka notes that the colonoscopy is five times better at detecting high-risk polyps than the CT colonography. With normal results, this procedure needs to be repeated every five years. If anything abnormal is detected, you’ll need to get a colonoscopy to remove it.
Think of this as colonoscopy lite: It requires the same prep but “it only looks up to the level of the first bend in the colon, and it only looks at the left side,” Dr. Nelson explains.
This procedure is less common than those previously listed and is really only useful in specific instances. “It tends to be for people who are experiencing bright red blood in their stool, because that’s usually an indicator that the blood is coming from an area that’s pretty close to the anus,” Dr. Issaka says.
Fecal Occult Blood Test
This test is considered an older-generation version of the FIT. It’s no longer used often due to its interaction with some medications and common foods like red meat. “If you don’t stop eating certain foods within a certain number of days before the test, or if you don’t stop certain medications, that fecal occult blood test may come back positive to indicate blood in your stool when there in fact is not,” Dr. Issaka says. It requires three samples of stool and needs to be completed once per year.
Just so you’re aware of all your options, here are two others you may have heard about. Septin 9 is a blood test that has been gaining popularity in recent years, Dr. Issaka explains. “What that’s doing is detecting these DNA changes that can be markers of colorectal cancer,” she says – however, it’s only recommended for those people who have declined other forms of screening. There’s also a “pill camera” which patients can swallow to take pictures of the colon, but Dr. Issaka notes that it’s also not the most accurate test out there.
Making the Choice
According to the U.S. Multisociety Task Force on Colorectal Cancer Screening, the colonoscopy and the FIT test are considered the best options for anyone at average risk for colon cancer. A colonoscopy is the only good option for someone at elevated risk. “It really comes down to the patients, their social support, and their personal preferences,” Dr. Issaka says. Whatever you choose, make sure you have a plan in place. “Although colon cancer screening is not urgent, it is not optional,” she urges. It could be the very thing that saves your life.
Additional reporting by Eric Butterman