Colonoscopy

Colonoscopy may be getting all the attention as the preferred way to screen for colon cancer, but a tried-and-true method that doesn’t require a hospital visit (or as much discomfort) may be just as effective

The most popular strategy for screening is colonoscopy, which however, involves a nearly 24-hour commitment to the preparation for this invasive and uncomfortable procedure. The benefit of enduring the screening, as doctors will tell us, is that if suspicious polyps are found, the colonoscopy can remove them at the same time. Plus, for most people it’s just a once-in-every-10-years ordeal.

colonoscopy

Though it is not the only way to screen for colon cancer, doctors and media have made it the default choice. This, despite the fact that no rigorous studies have shown that colonoscopy screening can actually lead to fewer deaths from colon cancer; medical organizations that include colonoscopies in their screening options have based their advice on the fact that detecting and removing polyps must logically lower incidence, and therefore death, from the disease.

Like all dogmas, this has been challenged recently. Concerns have been expressed about the emergence of colonoscopy as the default, pointing out that many people are uncomfortable with the procedure, and that globally, not every country can afford the test for every citizen beyond middle age. Even in the U.S., where the use of colonoscopy is high, access to the procedure is not uniform. For a country like India, cost considerations are also of crucial importance.

Dr. David Weinberg, at the Fox Chase Cancer Center, and his colleagues argue that fecal testing is just as effective as colonoscopy in detecting lesions that are potential colon cancers. He says  “From the patient’s perspective, the American health establishment prefers colonoscopy; I do think that’s probably true,” . That means people who are not comfortable with the procedure might not get screened for colon cancer at all.

There is therefore, a need to alert physicians and patients that alternatives do exist, including the fecal immunochemical test, which involves sending a sample of feces in a special kit to a lab for testing. The fecal test picks up signs of blood, which can be an indication that a tumor is present. If positive, a colonoscopy can then be carried out.

The fecal test however, requires yearly updates and means the physician has to follow up with the patient to make sure the test was done and then communicate the results when they arrive from the lab.The added work has made the once-in-10-years colonoscopy more attractive to many primary-care doctors, but Weinberg argues that if some people are bypassing screening altogether because they aren’t enamored with the colonoscopy, then doctors should be offering them the fecal testing so they do not miss screening for the cancer altogether. In the end, it is a matter of personal choicebut if scientific evidence is the important criteria then either strategy is equally effective at lowering risk of the colon cancer.