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New tests for colorectal cancer: An alternative to the colonoscopy?

Colonoscopy
The colonoscopy remains modern medicine’s gold standard in screening for colorectal cancer. And yet, despite its widespread use in helping to detect cancer early, an estimated 1 in 3 Americans, or more than 20 million people, ignore health officials’ recommendations to get regular colonoscopy screenings after the age of 50. Newer, simpler and cheaper tests are now hitting the market, and experts say they may offer patients viable alternatives as early screenings.

Nearly 50 years after it was first performed in 1969, the colonoscopy remains modern medicine’s gold standard in screening for colorectal cancer. And yet, despite its widespread use in helping to detect cancer early, an estimated 1 in 3 Americans, or more than 20 million people, ignore health officials’ recommendations to get regular colonoscopy screenings after the age of 50. Why? Many patients complain that the preparation—fasting and drinking an often-distasteful liquid laxative to flush out the colon the night before the procedure—is unpleasant. The colonoscopy may also remain unaffordable for some patients. Newer, simpler and cheaper tests are now hitting the market, and experts say they may offer patients viable alternatives as early screenings.

One option that is getting attention from patients and doctors alike allows patients to perform their own test, in the comfort of home. In August 2014, Cologuard® became the first at-home stool test approved by the U.S. Food and Drug Administration for the detection of cancerous and pre-cancerous genetic markers. Essentially two tests in one, it analyzes a stool specimen for DNA changes, while also measuring another sample for evidence of blood. Available only with a doctor’s prescription, the collection kit is shipped directly to a patient’s home. A small bucket with a sample container is provided to collect an entire stool sample, along with a separate tube for the collection of the sample for blood testing. The patient then returns the sample to the laboratory and is notified when results are available.

What is Cologuard?

Unlike colonoscopies, Cologuard does not require preparation or dietary or medication restrictions, but it is not recommended for patients who are under the age of 50, who have a history of cancer or have other risk factors. A recent, small study suggests such a test may help spot tumors in people who avoid colonoscopies and are not at high risk for colon cancer.

“Cologuard would be an option for anyone who refuses to have colonoscopy” says Jeffrey Weber, MD, Chief of Medicine and Director of Gastroenterology and Metabolic Support Services at our Phoenix hospital. “Any type of screening is better than no screening, and Cologuard is an easy-to-use option for the elderly and infirm, for whom a colonoscopy might be a higher risk. It is also important to remember that Cologuard is a test for the detection of cancer and not a preventative measure as is colonoscopy.”

A similar test, known as the fecal immunochemical test (FIT), is also used as an early screening for colorectal cancer. An option for healthy people who have no family history of the disease and aren't suffering from irritable bowel syndrome, the FIT uses antibodies to detect blood in the stool. The patient collects a small stool sample and mails the test kit to the lab. When performed annually, the FIT may help detect blood in the stool, an early sign of malignancy.

In the end, though, a colonoscopy may still be required to confirm signs of cancer or pre-cancerous DNA. As with Cologuard, if the FIT test yields positive results, your doctor will likely recommend a colonoscopy for further analysis. That’s because the colonoscopy, while unpleasant for some, is a more thorough screening technique with decades of proven results. During the exam, the doctor inserts a small thin tube with a camera at its end into the rectum, until it reaches the colon, to check for abnormal polyps, bleeding or suspicious masses. “Unlike colonoscopies, Cologuard does not detect small polyps, which are the easiest and safest polyps to remove,” says Dr. Weber. “It has been demonstrated that removal of small, benign polyps may prevent colon cancer later in life.”  

The Cancer Roundtable

To raise awareness among the 20 million Americans who skip their colorectal screenings, the American Cancer Society and the Centers for Disease Control and Prevention have launched an initiative called the National Colorectal Cancer Roundtable to spread the word that early detection saves lives. The goal: to see 80 percent of Americans screened for colorectal cancer by 2018.

“The bottom line is that only three countries in the world have seen their colon cancer rates decline in the past 20 years,” says Dr. Weber. “Those three countries—the United States, Poland and Germany—all use the colonoscopy to screen for cancer. In the rest of the developed world, where stool testing is used for colon cancer screening, colon cancer remains the number two cancer killer.”

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