Colon cancer screening without the dreaded prep

Colon cancer screening saves lives by finding precancerous or early cancerous growths during the most treatable stages. But no one looks forward to the colonoscopy test that’s recommended for people starting at age 50.

First there’s the dreaded prep that consists of gulping down a jugful of chalky tasting liquid. Then there is the time off of work for both the cleaning out of your system and the actual test. Finally, there is the colonoscopy itself, a test done under sedation that many find a bit embarrassing.

The colonoscopy is still the gold standard for colon cancer screening because it not only screens for suspicious growths, but removes the problems right at the same time, said Peter Hopewood, MD, of Cape Cod Surgeons in Falmouth, and an active member of the Cancer Committee at Falmouth Hospital. But he acknowledges there are some people who simply won’t do them.

There Are Other Options

Now there are a couple new ways that make screening easier and more doable.

A new at home test called Cologuard is getting some attention. The patient picks up a kit at the doctor’s office, packs up a stool sample at home and mails it to a lab. The lab then sends the results to the doctor. When the Food and Drug Administration approved Cologuard in 2014, Medicare quickly hopped on board to cover the test every three years.

There are some drawbacks to it, according to Dr. Hopewood. First of all, it costs $400 and many other insurances don’t cover it.

So, with that in mind, he recommends that all people over the age of 50 who don’t get a colonoscopy every 10 years get a Fecal Immunochemical Test (FIT) every year. It is done in the home just like the Cologuard, but is much less expensive. It also has a lower false positive of only 5 percent compared to 13 percent with Cologuard. A positive result from either test means you should follow up with your doctor to schedule a colonoscopy next.

The FIT test checks for the presence of human blood in the stool. The Cologuard test does the same but also looks for abnormal cells associated with cancer and precancerous polyps. Neither is as thorough as a colonoscopy, but a study in the New England Journal of Medicine that compared FIT tests with colonoscopies suggests that they might be just as effective because more people are willing to do them. More screening means more detection.

The FIT test has a traceable history that shows benefits. The Veterans Administration have been doing FIT tests in their outpatient clinics for over 10 years, and Dr. Hopewood said the results are very promising. He said the majority of colon cancers found nationwide are in stage 2 or stage 3 of development. At the VA, the numbers shift lower to stage 1 and stage 2, which are much more treatable.

“If everyone did a FIT test every year or a colonoscopy every 10 years starting at the age of 50, we can save 10,000 lives a year and prevent 40,000 more colon cancer cases,” he said. “It will take 10 years to catch up, but let’s make colon cancer a disease of the past.”

Another option for those who fear a colonoscopy is a CT colonography scan where the patient drinks the prep to clean out and then gets a CT scan. Sedation is not needed because the test is not invasive. The one drawback to this test is that insurance may not cover a follow-up colonoscopy needed if the CT test finds a polyp, said Dr. Hopewood.

Massachusetts Leads the Nation in Screening

The Centers for Disease Control and Prevention estimates that 30 percent of Americans between the ages of 50 and 75 years of age have not been tested for colon cancer. That fact prompted the American Cancer Society to propose an initiative called “80% by 2018.”

“The 80 by 18 initiative is that 80 percent of the American population be screened by 2018,” Dr. Hopewood said. “Massachusetts is almost there. We are at 78 percent and leading the nation.”

Colon cancer is preceded by benign polyps that grow like mushrooms, he explained. Eventually when the polyp gets to be a certain size, it may become malignant. As the malignant polyp continues to grow, it can block the intestine and bleed.

“If we can identify polyps before they become malignant, then we can prevent that polyp from becoming cancer,” he said. “The general recommendation is for everyone to get a colonoscopy at the age of 50 and then if they have no problems again every ten years.”

There are exceptions to the rule, he said. Anyone with a family history of colon cancer should be tested earlier. Patients with inflammatory bowel diseases like Crohn’s disease or ulcerative colitis should also be screened more often because inflammation of the bowels raises their risk of cancer.

Dr. Hopewood said an increased risk of developing colon cancer is a consequence of living in the western hemisphere – both the diets we eat and the environment we live in contribute.

The medical and scientific community believe the risks for colon cancer are:

• A diet high in processed foods
• A low fiber diet
• Lack of exercise
• Obesity

Many who think they are eating a high fiber diet may not be, said Dr. Hopewood. He recommends adding miller’s bran to baked goods and adding rehydrated dried beans and legumes – but not overcooking them – to your diet.

“The key is having soft bowel movements every day,” he said. “A lot of Americans don’t. The point being if there are carcinogens in our diet, by having slowed down bowel movements, they sit in the bowel longer and it exposes the lining to those carcinogens.”

[Featured image via the Colon Cancer Alliance.]