Colon cancer screening—everyone’s least favorite topic.

We all want to be healthy but who wants to think about having your colon examined, let alone the clean out process for a colonoscopy. So when a new non-invasive option comes out, everyone asks, “Is this ok to do instead of a colonoscopy?” But the real question is, “Is this as good at detecting colon (also known as colorectal) cancers and precancerous lesions as a colonoscopy?”
 
Colonoscopy is the gold standard, or best test to which all other options are compared to, for screening for colon cancer. Colonoscopy is a visual examination of the colon to look for polyps, or precancerous lesions, and cancer and remove these if found. It is considered a safe procedure with rare adverse events, less than 1 in 1000. It has also been shown to decrease the rates of colon cancer and improve mortality when cancer is detected.
 
However, no one likes to have the procedure done and that is why new, non-invasive options are always being developed. Hence, Cologuard. So what is Cologuard and how is it different than the other stool-based testing options out there?
 
Cologuard is a stool test to detect DNA changes that signal cancer has developed in the colon. A kit is sent to your house, you collect your stool and mail it back to the company. Your doctor gets the results and passes them on to you. Cologuard detects 92% of cancers in one study. It can even detect large precancerous polyps some of the time.
 
So if you can do a stool test, why does your doctor keep bothering you to get a colonoscopy? Cologuard isn’t for everyone. If you are at higher risk for polyps or colorectal cancer, colonoscopy is still the best option for screening. People with a family history of colon cancer or with a genetic syndrome putting them at risk for colon cancer don’t qualify for stool based testing. If you’ve ever had polyps removed before, you still need to get a colonoscopy.
 
And as mentioned before, colonoscopy is the test all other options are compared to. If your stool-based screening test comes back positive, you then have to get a colonoscopy. And unfortunately, insurance only covers one screening test. Meaning, the follow-up testing is no longer considered a screening and is applied to your deductible.
 
Colon cancer is the fourth leading causes of cancer and second leading cause of cancer-related deaths (cancerstatisticcenter.cancer.org). Of all the screening options for different cancers, colon cancer screening remains the lowest utilized. So talk with your doctor about your options. And find out the best way to keep your gut happy and healthy.
 

About the Author

Marla Wolfert, MD, is a board-certified, fellowship-trained gastroenterologist with Prevea Health. She completed medical school at the University of Wisconsin School of Medicine and Public Health, and a residency at the University of Illinois in Chicago. Dr. Wolfert completed her fellowship in gastroenterology at Loyola University Health System in Illinois. She works with patients to promote health through education, lifestyle changes and medications.