I finally took a big leap this year – colon screening. I’ve been avoiding it. As usual, once something comes into your life you notice it repeatedly, like deciding to purchase a car and then noticing the model on the road everywhere.
Soon after I took action, I read startling health news. While the rate of new colon cancer has dropped for older adults, it has been rising for those under 50. Within 10 years, the rate of colon cancer for that age group rose from 10% to 12.2% (a big jump in a short period of time). Worse, those under 50 accounted for more than half (51.6% to be precise) of stage III and IV cancer cases compared to 40% for older adults. Shockingly sad.
“Our findings that colorectal cancer risk for millennials
has escalated back to the level of those born in
the late 1800s is very sobering.”
— Rebecca Siegel, MPH
American Cancer Society (ACA)
Conversely, over the last decade or so, there has been a 30% decrease in colon cancer mortality in people older than 50. There are other contributing issues. Yet, one word describes the greatest difference of risk between these age groups – screening. Younger people, and their physicians, rarely consider cancer unless the symptoms become too regular and consistent to ignore. The ACA is now recommending screening by the age of 45 years old, a jump of 5 years sooner.
That brings us to the choices of screenings for all ages.
Screening Options and Choices
No test is 100% accurate. Start with that in mind. Each test has its benefits and disadvantages, risks and rewards. I alert you in advance to the fact that my portrayals are likely biased. Also, as is often the case in health writing, one must remind readers to consult with their physician. However, it’s good for us to understand the options and what might be best for our individual situations. Moreover, if you would be willing to pursue one type but would totally avoid another, then the variances of the choices are inconsequential – meaning chose what you would really follow through on.
Colonoscopy
The most accurate test with a claimed cancer-capture rate of 90% (not totally proven yet) is the colonoscopy. I admit I’ve never had one, and it’s for all the same reasons others avoid it: discomfort of the pre-day prep, laxatives, time off from work, sedation and the invasive procedure itself. I have friends (professional and lay) who claim the prep has improved drastically. Nevertheless, so far, I remain one of the 23 million or more American adults who have not been screened by a colonoscopy. Luckily, it isn’t the only option.
Aside from the accuracy of a colonoscopy, this traditional procedure has one markedly superior benefit – namely, if polyps are found, they can generally be removed during the same procedure. That last benefit can have a dark lining however – as the cost can be increased and patient required to pay more if the screening turns into a removal procedure (whether you have Medicare or regular insurance). It’s worth it, but best prepare your pocketbook for that possible outcome. If there is no family history, and no polyps, you may not have to reschedule the next test for another 10 years.
[Interesting Tid-bit: recent research may indicate that the colonoscopy is better at detecting growths in the left colon than the right. I’ll report more on this if I learn why that is so.]
Virtual Colonoscopy
The virtual type incorporates a CT scan (with small dose of radiation) and is best at detecting larger polyps. Smaller ones or flat lesions can be missed. While you don’t need sedation there are downsides. Foremost, it requires the same preparation as a colonoscopy. Surprisingly, it is not without discomfort since the colon is inflated with gas (for the best view).
As mentioned, it’s not considered as accurate as a traditional colonoscopy. In some states it doesn’t always require a doctor’s order but it is generally neither covered by Medicare nor many other insurances. The next downside is that if polyps are detected you will probably require a traditional optical colonoscopy to follow up and remove the growth. [“That means two rounds of prep” you may moan.]
Take Home Fecal Tests
At-home fecal tests are easy. They’re yearly tests and definitely worth the small cost if you plan to do nothing else. There are 2 types: Fecal Immunochemical test (FIT) or the Fecal Occult Blood test (FOB).
Despite their names, both check for traces of occult (hidden) blood in the stool. This CAN be an indication of cancer, but not necessarily as the presence of that blood may indicate other conditions, including (but not limited to) hemorrhoids, anal fissures, infections, ulcers, Crohn’s disease or diverticulitis.
The FIT is first line of defense in most countries of the world and its effectiveness for general population screening is endorsed by The National Colorectal Cancer Roundtable. The FIT test is asserted to detect about 73 % of colorectal cancers. Pretty good considering the price. Some organizations opine that since you take this test every year, and that means 10 screenings over 10 years, it may equate to the scrutiny of one colonoscopy (which is recommended for every 10 years).
Your physician may have these packets on hand and it takes little more than a smear of feces collected from a paper (later dumped in toilet) with a small sterile vile. It has very little ‘yuck’ factor. They can cost as little as $10 and generally not more than $25-30, which is covered by most insurance, including Medicare. Unfortunately, although not surprising, if the test is positive, you will probably need to schedule a colonoscopy.
Cologuard
A newer test which you probably have seen advertised is Cologuard. It requires a prescription (although I am really uncertain why). Like FOBT or FIT it’s done in your own home and requires no preparation. The materials are substantial, and make you wonder about land fill waste if you tend to lament about recycling and ‘green’ concerns. The directions (both printed and online) are very descriptive. There’s even a video on how to use it.
[One hint for Ladies. The directions, which instruct you not to allow urine into the collection container, may take some practice the days before. Men’s plumbing makes this small aspect of the test much easier.]
After sending it off to the lab, the sample is examined not only for blood, but for cancer-linked DNA in the stool. The accuracy of the test is listed as 92-93% for positives. This is a bit puzzling, and I am still trying to figure out the fine print, considering that a traditional optical colonoscopy (substantially more expensive) is rated at approximately 90%. [I found NO details, but wonder about this 92-93% in comparison to traditional colonoscopy. Could Cologurard include false positives as well? It is fact that the test is much less effective for pre-cancerous screening.]
Cologuard pricing is around the $600 range and will be paid for by most insurers, including Medicare. It is recommended to be repeated more frequently (once every 3 years) than a colonoscopy (recommended for every 10 years or less depending on history). On the other hand, given the lack of invasiveness, less cost, and the ease of the steps done at home, Cologuard gets extremely high marks, especially if their detection success rate proves to be true.
Sigmoidoscopy
This test, recommend for every 5 years, has some drawbacks. First, it detects cancers only in the lower colon. Thus polyps in upper colon can easily be undetected. This procedure is generally a referral only for those with low risk factors. There is some prep beforehand (a clear liquid diet and then laxative before procedure) but it doesn’t require anesthesia. Although for those very nervous, a sedative may be prescribed (the patient’s muscle tension weighs into this deliberation).
A thin, flexible tube (with tiny camera) is inserted into the rectum. All I know for sure is that this sounds like a pain in the rear-end. (Yes, pun quite intended). I am told that anesthesia is rare, and the procedure is usually done without it, or sedatives. Upon pain, the tube can be repositioned or removed and reinserted. Oh boy, that’s a relief. This wouldn’t be my choice. In some circumstances, like abhorrence to anesthesia or a blocked situation that could otherwise cause infection, this might be a good alternative. Additionally, there may be some special advantages that I didn’t catch.
PillCam Colon Z
One possible other alternative (for rare use) is the PillCam Colon Z, a tiny camera in pill form which is battery-run and disposable. After you swallow it, movement begins. It works its way through your system over 10 hours or so. The camera transmits color images of its route to a monitor you wear externally – and conveys info back to your doctor.
At this stage, it appears the pillcam is only recommended for those who would have extreme difficulty with a colonoscopy. But, can you believe it (?) you would STILL have to endure the same cleansing prep as with a regular colonoscopy. Unlike the traditional procedure you can’t have any discovered polys immediately removed. Seems a bit unfair. Again, this wouldn’t be my choice unless I fell in the category of those unable to benefit from another screening.
The Symptoms
Just a reminder of some of the common symptoms, which require attention (especially if more than one):
- Rectal bleeding
- Dark stools or blood in stool
- Cramping and/or abdominal pain
- Feeling that you need a bowl movement, but it’s not relieved after having one
- Weakness and fatigue – unreasonable for your lifestyle behaviors
- Unintended weight loss
FINAL THOUGHT
I’ve used two of these procedures. I admit I put them off. I delayed them not with any rational thought, but more like Scarlett wanting to think about it tomorrow. Yet, these days, the testing is becoming easier and less invasive. Basically there is little justification left to resist. The idea of “the test” may hit you in the gut (hmmmm) but the results are either going to give you peace of mind, or set you on the treatment path early (for better outcomes). Unfortunately, but apropos, I say “grin and bear it.”
Similar to diets and exercise in which case the best type is always the one you will stick with, there is a lesson there for colon screening as well.
“The only thing you should be asking yourself
and your doctor is which test is right for you.
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.”
— Dr. Deborah Fisher, MHS,
Associate Professor of Medicine, Duke University.
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Picture credit: skeletons anatomical by slon_pics via pixabay-2261006_1920.jpg
Just received a call from my dr to schedule a colonoscopy after having multiple (hopefully pre-cancerous) polyps removed from my uterus. 🙁 Getting old sucks!!
Getting old may seem to “suck”, but as they say, it beats the alternative. Good luck on your tests.