Are There Alternatives to Colonoscopy?
is the gold standard when it comes to detecting and preventing colorectal cancer
, especially for those with a family history of colon cancer or a history of inflammatory bowel disease. But while it’s the best preventive method, many people hesitate to have a colonoscopy—often fearing the test preparation or the invasiveness of the procedure.
UR Medicine gastroenterologist Dr. Danielle Marino describes the colonoscopy and explains some screening options for those with average risk of colorectal cancer.
Before having a colonoscopy, patients must follow some dietary guidelines and take some medications to clean out their colon, so the camera can see the colon lining. During the procedure, the doctor inserts a long tube with a camera into the rectum up to the start of the colon. The camera moves through the colon looking for polyps and removing them if they are found. Patients are under moderate sedation during the test and most sleep through the whole thing. If polyps are removed, they are sent to a lab for testing. The test results determine when the patient should have his or her next colonoscopy.
There are three colon cancer screening tests that may be done at home by collecting stool, smearing it on a card or using a Cologuard kit, and sending it to a lab.
Fecal occult blood test: The fecal occult blood test essentially looks for blood in the stool. It only picks up about 30 percent of polyps, so it is not very reliable at catching polyps before they become cancerous. It picks up cancers about 70 percent of the time.
Fecal immunochemical test: The fecal immunochemical test (FIT) picks up polyps and cancer better than the fecal occult blood test, but it’s not as good as a colonoscopy.
Cologuard: In 2015, the FDA approved Cologuard, which can detect blood in the stool as well as different DNA mutations that are associated with colon cancer. This test picks up about 90 percent of colon cancers and 40 percent of polyps. The downside is it still may only pick up a polyp once it is larger or in a more advanced stage.
Your primary care provider should be able to provide you with the card for the fecal occult blood test and the FIT test. For Cologuard, the company sends a whole packet to your home.
Another screening option is CT Colonography. This procedure still requires cleaning out the colon but is often only covered by insurance if a patient’s colonoscopy failed. For this test, a radiologist inserts a tube into the rectum, fills the colon with air and takes a CT scan.
With any of these alternative methods, if the test is positive, the patient will need to have a colonoscopy. Although a colonoscopy is the best way to prevent and detect colon polyps and cancers, getting screened in some way is what matters. Any screening is better than nothing.
Those who are uninsured or underinsured can do a free FIT test from Cancer Services Program of Monroe County, and if something is found on the FIT test, the program will pay for a diagnostic colonoscopy free of charge. They do not pay for screening colonoscopies. If you need help, call (585) 224-3060.
Help raise awareness of colon cancer and funds for patient care and research by joining us for the Strollin' for the Colon 5K walk/run on Saturday, May 13, in Geneseo. Click here for details.
Danielle Marino, M.D., is an assistant professor in the Division of Gastroenterology and Hepatology. She specializes in gastroenterology at UR Medicine’s Strong Memorial Hospital.
Lori Barrette |