Wednesday, January 9, 2019

Coming to the Clinic – Part 8 - The Bottom Line

My goodness, it has been since the end of August that I have added to this series. About time I get back to it.

Today we are going to discuss one those places no man or woman ever wants to go. Or wants their doctor to go. But it’s not nearly as bad as you think. That place is your colon, a place where cancer may be lurking. And if it is, by the time you have symptoms (such as weight loss, blood in stool, change in stool, abdominal pain), it may be too late. So, if you are over 45 to 50 years old (or even 40 in high risk individuals), you need to take this seriously, and go get your colon checked.

There are a number of different tests which can do this. I’m going to outline the most common screening options for the majority of the population at average risk.


Colonoscopy is the gold standard in routine colon screening. It is the only colorectal cancer screening tool that is both diagnostic and therapeutic. Not only does colonoscopy perform a complete evaluation of the colon, if any precancerous growths (called polyps) are found, they can usually be removed right away. If anything else looks abnormal, a biopsy can be done. Because this is such a thorough exam, it only needs to be done every ten years.

Having a colonoscopy requires a complete bowel prep the night before to cleanse the colon. Because you will be sedated, you need to take a day off work and will need a ride there and back home again. On very rare occasions, complications may occur such as a bowel perforation. Since it is a procedure, done in your doctor’s office or hospital, it is more expensive, but when used as a screening tool, most insurance carriers cover it.

Fecal immunochemical testing or FIT

FIT is probably the easiest way to check for colorectal cancer and is totally non-invasive. FIT detects tiny amounts of blood in the stool that could be a sign of cancer or large polyps. You get a simple kit from your doctor’s office, put a small amount of your stool into the kit and return it to your doctor’s office or the lab. There’s very little prep, it’s inexpensive and you don’t have to take time off from work. However, FIT is not as effective as colonoscopy at finding cancer or polyps, so it needs to be done every year. Also, if your result comes back positive, you will still need to have a colonoscopy. FIT has a false positive rate of about 5 percent, often times caused by ulcers or hemorrhoids.

Cologuard or FIT-Fecal DNA Test

This test is the newest in the battery of colon screening tools. It checks for both blood and DNA markers, which can be a sign of cancer or pre-cancerous growths. It is non-invasive and done in the comfort of your home. After your healthcare provider orders the test, a kit is shipped directly to your home with instructions explaining how to complete the test. After collecting your stool sample, the kit is sent directly to a laboratory for processing and analysis. The test should be repeated every three years.

No special diet or bowel prep is required for a stool DNA test. However, if the test does show a possible cancer or pre-cancer, you would need a colonoscopy.

Here is something to keep in mind with both the Cologuard and the FIT test. As already mentioned, a routine screening colonoscopy is covered by most insurance carriers every ten years. The Cologuard and FIT test are also usually covered, but if either one of them comes back positive and you need to move onto the colonoscopy, it is no longer considered screening. It will be considered a diagnostic test and most insurance companies will no longer pay for it. It sounds like a scam, but I’m giving you the inside scoop here, both literally and figuratively.

Bottom Line (also literally and figuratively)

When colorectal cancer is found early, before it has spread, the 5-year relative survival rate is 90%. This means 9 out of 10 people with early-stage cancer survive at least 5 years. But if the cancer has had a chance to spread outside the colon or rectum, survival rates are lower. (American Cancer Society website)

So whichever screening tool you think would work best for you, talk to your healthcare provider, and then follow through.
Next week: Which screen did I go with? 

Just some random food from the coast of Kenya, coz I couldn't post a picture of what it looks like at the other end. 

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