The problem is that if someone doesn’t get screened because they don’t want to go through the expense or unpleasantness of a colonoscopy, then the exam isn’t effective at all.
Those without a family history of colorectal disease or other risk factors have a variety of alternative tests to choose from.
Several alternative tests, some of which have been around for a while, are now getting a closer look. Experts like Allison and Wender say doctors should be recommending them more to patients, especially those who don’t want or can’t afford a colonoscopy.
One option is the fecal immunochemical tests, or FIT, which are approved by the Food and Drug Administration (FDA). It’s used as the first line colorectal cancer screening test in most of the world, including Canada, Israel, the Netherlands, Italy, France, Taiwan, China, South Korea, Scotland, and soon, England. It’s recommended as the screening test of choice by the European Union Guidelines.
FIT is a stool test and can be ordered by your doctor. There are different kinds of FIT tests, both wet and dry. Allison recommends you check to be sure your test has “evidence of its performance characteristic in large average risk populations and evidence of quality control over development and interpretation.”
If your FIT test is negative, you repeat the test a year later. If the test is positive, you’re advised to schedule a colonoscopy. FIT costs about $20 or less and is covered by Medicare and most health insurance plans.
A single FIT test detects about 73 percent of colorectal cancers. But because you use FIT every year, 10 screenings over 10 years make it just as good as one colonoscopy every 10 years, Wender said.
The National Colorectal Cancer Roundtable has endorsed FIT-based testing as an effective means to screen the general population for colon cancer.
There are other stool-based exams on the market too.
One is stool DNA, or sDNA. It’s another at-home stool test ordered by a doctor. The test looks for blood and abnormal DNA in the stool that may indicate the presence of colon cancer or precancerous polyps. If the test is positive, you will need a colonoscopy to remove any cancer or polyps.
The high-sensitivity fecal occult blood tests FOBT, include the sensitive guaiac test and FIT. Each has markedly improved detection rates of colorectal cancer and advanced adenomas than the old standard guaiac FOBT. Modeling studies have shown high sensitivity FOBT to be as effective as a colonoscopy if done every year.
The newest stool test is called Cologuard. It’s recommended every three years. It costs $649 and is covered by Medicare and some private health plans.
The American Cancer Society and other organizations also recommend several other screening tests.
One is a flexible sigmoidoscopy. In this procedure, a short, flexible tube — a sigmoidoscope — is inserted into the rectum to look for polyps and cancer in the lower part of the colon. It also requires a cleaning prep and the procedure can cause cramping.
The test is recommended every five years but is not often used in the United States because a colonoscopy requires similar preparation and checks the entire colon. The reimbursement for a sigmoidoscopy is also less than the cost to the doctor for doing the test.
The final recommended test is CT colonography, sometimes called a virtual colonoscopy. It’s an X-ray procedure to inspect the colon. It too requires the same special diet and bowel prep as a regular colonoscopy.
Virtual colonoscopy does not require sedation but can be painful because the colon must be inflated with gas to provide a better view. If polyps or other abnormalities are seen, you will need a regular optical colonoscopy to remove the growths.
In addition, CT colonography is not yet CMS approved for Medicare reimbursement. Wisconsin is the only place in the United States where you can get the test reliably covered by insurance.
With all these alternatives, medical experts say there’s no reason for people not to get screened. Shaukat said colon cancer is one of the few cancers for which there is a wide variety of screening tests.
“There are a lot of good options out there,” said Shaukat. “If it takes a stool-based test to get someone in the door to get screened, then so be it.”
There are patients who worry about the accuracy of some of the alternative tests, but Allison said no exam, including a colonoscopy, is a 100 percent guarantee there are no polyps or cancer in your colon or that you won’t develop colorectal cancer in the 10-year interval recommended between tests.
“No test is perfect,” he said.
Whatever test you choose, medical experts say the important thing is to get screened. If you’re between the ages of 50 and 75, colon cancer screening is an absolute must, they say.
“The only thing you should be asking yourself and your doctor is which test is right for you,” said Dr. Deborah Fisher, MHS, an associate professor of medicine at Duke University. “There is no one test that is best for everybody. When it comes to colorectal cancer, the best test is the one you actually use.”
“People say ‘I feel fine, why should I go through such an unpleasant test.’ You can talk yourself out of it.” — Dr. Richard Wender, American Cancer Society
“If we catch colorectal cancer early, more than 95 percent of patients are still alive five years later.” — Commander Djenaba Joseph, Centers for Disease Control and Prevention
“When it comes to colorectal cancer, the best test is the one you actually use.” — Dr. Deborah Fisher, Duke University
This piece was originally reported on March 20, 2015. Its current publication date reflects an update, which includes a medical review by Cynthia Taylor Chavoustie, MPAS, PA-C.
