Alethea Fleming, ND

New Options for Screening Colon Cancer That Don’t Require a Colonoscopy

The answer is….maybe. Or perhaps more accurately, maybe not as often as has been routinely recommended. The United States Preventative Services Task Force (USPSTF) currently recommends that all adults start screening for colorectal cancer starting at age 50 and continue routine screening through age 75. From 75-84 the recommendation is up to patient and physician discretion (based on personal and family history) and after age 85 the USPSTF does not recommend routine screening.

Screenings So Far

Screenings thus far have been a colonoscopy every 10 years starting age 50, with fecal occult (poop smear looking for blood) every 1-2 years. If you have a family history of colorectal cancer and/or a personal history of inflammatory bowel diseases such as ulcerative colitis or crohn’s disease, or a prior history of pre-cancerous polyps, then the interval between colonoscopies may be as little as 2-5 years.

More Than Just Cancer Screening

Colonoscopies help us screen for colon cancer, but they also give an excellent view of the physical structure of the bowel. This allows us to see inflammation, hemorrhoids, changes in bowel structure or lining, or other physical alterations to the large intestine. It is reasonable for everyone to have at least one at the appropriate recommended time for each individual.

What if you are a patient who has never had much trouble with your gut, went ahead with your first colonoscopy and had a perfectly happy beautiful result? If nothing changes in that next ten years regarding symptoms and lifestyle you might be questioning the need to go through the rigorous prep and moderately invasive procedure again. Or, perhaps you are otherwise unable or unwilling to have a colonoscopy at all. Thankfully this does not mean you have no options for screening for colon cancer.

Stool Test

The most common first recommendation is a stool (poop) test screening for the presence of blood. This can be done in office with your health care provider as part of a routine exam if a rectal exam is needed with a guaiac smear that shows the presence of blood with a color change on the paper. This can also be done by providing a stool sample to the lab for a fecal immunochemical test which tests for antibodies to blood (more sensitive than guaiac). These tests are not very sensitive, but are a non-invasive way to screen patients.

Cologuard Test

Now there is another stool test available which looks directly for DNA shedding of cancer cells instead of looking for the presence of blood. The Cologuard test is 92% accurate at detecting the presence of cancer and is still just a simple at home test stool kit. A physician can order the test and have the kit sent to the patients home. The patient will then complete the test according to the instructions and mail the sample back. Results will come to the ordering physician who will then discuss it with the patient. Medicare currently covers this test, and some private insurers do as well. This test is designed for normal risk patients, like illustrated above, not for patients with known high risk or inflammatory bowel conditions.

Conclusion

A colonoscopy every 10 years starting at age 50 is still considered the gold standard for colo-rectal cancer screening, but the Cologuard test provides a safe new option that may improve access and patient compliance.


Dr. Alethea Fleming, ND is a passionate advocate for naturopathic geriatric medicine. A 2007 Bastyr University graduate, she also earned a certificate in Gerontology from the University of Washington. Dr. Fleming is the owner and lead physician of the Vital Aging Clinic in Anacortes, Washington where she provides primary care to all adults as well as adjunctive geriatric care. Dr. Fleming is active in multiple community organizations as well as a member of WANP, AANP and OncANP. In her off hours, Dr. Fleming can be found hiking the beautiful trails of Fidalgo Island, spending time with her wonderful husband and son, or with her nose firmly in a good book.

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