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Don’t Want a Colonoscopy? There Are Alternatives

March 07, 2023

When it’s time to have your first colon cancer screening, you can’t go wrong with a colonoscopy. It is the gold standard for tests that can catch colon cancer or precancerous polyps early enough to significantly improve your chances for a cure.

Some people, however, may be concerned about the bowel preparation process, cost (even though most insurers cover these preventive procedures) or the prospect of having to take time off work.

Fortunately, there are other options available. Be aware, though: With these alternative tests, any indication that you might have cancer will need to be followed up with a colonoscopy.

Colonoscopy Alternatives

You also need to understand that there are some major differences between these tests and a colonoscopy.

If you have average risk factors, a colonoscopy is recommended once every 10 years. Because the alternative options are less accurate, they need to be repeated much more frequently – sometimes annually. Another advantage of the colonoscopy is that your doctor can remove and analyze potentially troublesome polyps (clumps of cells that form on the walls of the colon) during the procedure. If the alternative tests suggest there could be an issue, you’ll still have to have a colonoscopy.

Among the alternatives:

Fecal immunochemical test (FIT): This test looks for hidden blood in your stool. It takes advantage of the way larger blood vessels in colorectal polyps or cancers will often shed blood during the passage of stool. These damaged vessels will leak blood into the colon or rectum, but there is often not enough in your stool to be seen with the naked eye.

This test, which can be purchased over the counter,  includes a brush or other small tool that you will use to collect a sample of your stool. Carefully follow the instructions, which can vary by test, and return the sample. Blood in your stool could indicate cancer or polyps, but it also could be related to other conditions, including ulcers. The test is repeated annually.

Stool DNA test: This test also looks for hidden blood in your stool. But it also searches for abnormal sections of DNA that could indicate the presence of cancer or polyp cells. These cells often develop genetic mutations, which can be passed into the stool. The only FDA-approved test available in the U.S. for stool DNA is the Cologuard, which requires a prescription.

The collection method for this test is similar to the FIT test, except that you will collect your entire stool sample to send to the lab. The kit includes tools to make the collection as easy as possible. Collection can be done at home, after which you will return the sample by way of a provided shipping container. The test is repeated every three years.

Guaiac-based fecal occult blood test (gFOBT): The test looks for blood in the stool through a chemical reaction. It has similarities to the FIT test, though there are important differences. It can detect unseen blood in your stool, but certain foods and medications can cause false positives. You may be asked to avoid some things – including red meats, ibuprofen, aspirin and high doses of Vitamin C – for up to a week before taking the test.

Collection of samples is similar to the FIT test, though you will need to get samples from three or more separate bowel movements. The test, which can be purchased over the counter, is repeated every year.

CT colonography: Also referred to as a virtual colonoscopy, this test uses a computed tomography scanner to create images of your colon and rectum. With the aid of computer, the images are combined to produce a highly detailed view of the inside of those organs.

This test requires the same bowel prep as a colonoscopy and is repeated every five years.

Screening Guidelines

Frequency of screenings is impacted by a wide range of factors, including the type of test you are using and your own risk factors. The latest guidelines by the U.S. Preventive Services Task Force recommend that adults age 45 to 75 be screened for colorectal cancer. The starting point for screenings has moved lower in recent years because of an unexplained increase in colorectal cancer in people 30 to 50 years old. And if you have a family history of colon cancer, personal history of cancer or other polyps, you may need to start screening before the age of 45.

Colorectal cancers are among the most curable cancers. But the key is catching them early. If you wait until the symptoms have become obvious, that decreases your chances of a cure. So, if you’ve had a change in bowel habits or noticed blood in your stool, don’t write it off as hemorrhoids or some other minor issue. Talk with your doctor to determine what’s best for you.

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