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A No-Prep Way to Prevent Colon Cancer

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Have you been screened for colon cancer yet? If you’re at least 50 years old, you should be saying, “yes.” Then again, only 65% of adults who should be screened are up-to-date about it, and 28% of adults who should be screened never have been.

The good news is that a noninvasive test that screens for colon cancer is now available. It’s not the first noninvasive test for colon cancer…it’s not entirely pretty…and it does not provide a complete guarantee that you can sidestep a colonoscopy—but it can be a good option for people who want to be assured about colon health but also want to avoid a colonoscopy if at all possible. See if it’s right for you…

THE OLDER COLON TESTS

A good old-fashioned colonoscopy is still the most thorough and proactive screening for colon cancer, since doctors can not only see what’s “up there” in real time but can also snip out any suspicious polyps in the process. But, of course, colonoscopy is expensive and time-consuming, the prep (as we all know!) is fairly horrendous, and the procedure itself is not without risk. The colonoscope can pierce the colon and, although rare, cardiopulmonary problems can result from the anesthesia.

Two other colon-screening options you might have already heard about include sigmoidoscopy and fecal occult blood testing. Sigmoidoscopy uses a scope that is shorter than the one used for colonoscopy and examines only the lower part of the colon. A fecal occult blood test, also called a fecal immunochemical test, looks for blood in a very small stool sample that the patient collects at home and then mails to a lab in a special envelope. If an abnormality is found with either of these screening tests, a colonoscopy is then done to confirm the diagnosis and continue with next steps, such as removal and biopsy of polyps.

A NEW OPTION

The newest test, called Cologuard, is similar to but more thorough than fecal occult blood testing. It detects colon cancer by examining a stool sample for the presence of blood and also abnormal DNA. To find out whether Cologuard was as good as or better than fecal occult blood testing, its manufacturer sponsored a research study that was conducted at the Indiana University School of Medicine in Indianapolis.

The study included 9,989 men and women from around the United States and Canada. All of them were given a colonoscopy, a fecal occult blood test and a Cologuard test, and the results were compared.

The results: Cologuard was a cut above fecal occult blood testing. Cologuard correctly identified 60 of the 65 cancers detected by colonoscopy and 321 of the 757 advanced polyps detected by colonoscopy. (Advanced polyps are those that are either one centimeter or larger and/or have abnormal cellular DNA.) In comparison, only 48 cancers and 180 advanced polyps were detected by fecal occult blood testing.

On the downside, the Cologuard test was associated with nearly three times more false-positives than fecal occult blood testing. This means that some people who opt for Cologuard because they want to avoid a colonoscopy may end up having to get one anyway to confirm that they do not have colon cancer or precancerous polyps. The false-positives were much more commonly seen in older adults and may have to do with age-related DNA changes or with Cologuard’s ability to detect minor polyps, which are very common with increasing age, the study’s lead scientist, Thomas Imperiale, MD, told Daily Health News.

IS IT RIGHT FOR YOU?

Dr. Imperiale said that the Cologuard test is for people who do not have risk factors or signs of colon disease but who want to be screened to make sure that all is well and remains so. Folks who have lower gastrointestinal pain or bloody stools, a personal or family history of polyps or colon cancer or who have inflammatory bowel disease (Crohn’s disease and ulcerative colitis) aren’t eligible and would have to bite the bullet and go for colonoscopy instead.

What’s involved in a Cologuard test? You receive a test kit by mail. The kit contains everything you need to collect and package two stool samples, including a special receptacle that fits over the toilet bowl and a liquid preservative. Then you send the samples to the lab in a box that comes with prepaid postage. No special dietary restrictions, preparation or time off from work is required.

If the lab detects blood or abnormal cells in the stool samples, you’re told to get a colonoscopy. If all is well, no worries. You repeat the test in another three years instead of annually, which is the frequency required for fecal occult blood testing.

The cost of the Cologuard test is $599, and it is covered by Medicare Part B for people who are 50 to 85 years old. Private insurance companies generally, but not always, cover what Medicare deems is coverable, so if you have private insurance, check in with your provider to find out whether it currently covers or intends to cover Cologuard if you are interested in this colon cancer screening option.

Cologuard seems to be a step up from fecal occult blood testing in its ability to detect nearly as many colon cancers as colonoscopy. It also provides a bit more information than fecal occult blood testing about where a person stands in terms of colon cancer risk—but the fact remains that it can’t match the thoroughness of colonoscopy. If you, for whatever reason, simply refuse to have screening colonoscopies, then Cologuard could literally save your life, so be sure to ask your doctor about it. If you are willing to have screening colonoscopies but are considered at low risk for colon cancer, it might also be an option for you—again, discuss it with your doc.

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Source: Thomas F. Imperiale, MD, professor of medicine, Indiana University School of Medicine and research scientist, Indiana University Medical Center–Regenstrief Institute, both in Indianapolis. His study was published in The New England Journal of Medicine. Date: December 15, 2014 Publication: Bottom Line Health
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