On the list of the top 10 things to do on your day off, a colonoscopy sure isn’t one of them.
If you’re 50 or older, guidelines recommend that you get a colonoscopy every 10 years to check for precancerous polyps and colon cancer. This screening test allows your doctor to view the rectum and entire colon, and sedation is used for most colonoscopies in the United States. If a polyp is found, your doctor can take a biopsy or remove the polyp. Side effects are rare, but bleeding or a tear in the colon can occur.
However, despite the guidelines, only about 1 in 2 of us do our due diligence, which includes drinking down about a gallon of a liquid that will trigger bowel-clearing diarrhea, then marching down to our local colonoscopy center to have a tube inserted in our you-know-what.
Happily there’s another way. Guidelines also recommended an annual at-home fecal occult blood test (FOBT).
“Even though in the United States the most common screening test for colon cancer is colonoscopy, the at-home fecal occult blood test is easier, takes far less time and has lower costs compared to colonoscopy,” said Dr. Thad Wilkins, a family physician with Augusta University Family Medicine.
Not only that, but the test is highly effective. In fact, a review of scientific literature on the FOBT finds that it has the highest level of evidence in reducing deaths from colon cancer, more so than any other test, including colonoscopy (at this time; studies are still ongoing).
The ick factor?
So one thing you should know: If you do the at-home FOBT, it does mean that you have to handle your own stool (yikes!). But it’s not quite as “ick” as you might think.
You can talk to your doctor about getting one of the tests, which are covered by most insurance. The FOBT checks for the presence of blood in your stool, which could be a sign of a polyp. Before the test, you’ll need to avoid eating rare red meat (because it’s bloody!), along with horseradish, cantaloupe, raw turnips, broccoli, cauliflower, red radishes and parsnips. Also avoid taking high-dose aspirin or other anti-inflammatory drugs for seven days prior to and during testing, or vitamin preparations that contain vitamin C for two days prior to and during testing.
The kit is surprisingly simple. It includes the following:
- An envelope containing instructions
- Several large sheets of flushable tissue
- Three small wooden wands
- A card to collect samples
- A return envelope
Just float the tissue on the toilet water to create a “net” in which you can catch your stool, quickly use a wooden wand to smear a bit of a sample into a slot on the card, and that’s it. You’ll need to get three samples before sealing the card and mailing it back to your doctor, who will test it and give you the results.
According to Wilkins, if your results with the FOBT are negative year after year, the great news is that you don’t have to go in for additional screening – ever. (No colonoscopies? Most of us would sign up for that!) But a positive result does mean you need a follow-up colonoscopy just to check.
The right test for you
Besides FOBT or colonoscopy, other colon cancer-specific screening tests are available (and as with FOBT, if the test is positive, a colonoscopy will be necessary). A few of them are as follows:
- The FIT or fecal immunochemical test also checks for the presence of blood in the stool, specifically human globin, a protein that makes up our hemoglobin, which means that there are no dietary restrictions with this test. Its results are also comparable to the FOBT, and like it, it can be used to screen for colon cancer every year.
- Flexible sigmoidoscopy requires a bowel prep, but it is less intense than the bowel cleansing for a colonoscopy. It can also be performed in a doctor’s office without sedation. This test only examines the lower part of the colon (but note that any polyps in the upper part of the colon may be missed). Its results are also comparable to FOBT in decreasing deaths from colon cancer, and guidelines recommend patients undergo flexible sigmoidoscopy every five years.
- A newer and more advanced test is the multitargeted stool DNA test (Cologuard™), which combines the FIT with testing for altered DNA in cells shed into the stool. A full stool sample is required. This test is recommended every three years.
“But no matter what test you use, the main thing is that if you are 50 or older, you need to be screened for colon cancer, which is the third most common cause of cancer-related death in the United States,” Wilkins said. “There are a variety of colon cancer screening tests available that patients can discuss with their physicians to find one that’s suitable for them. With screening, we can hopefully identify precancerous lesions or polyps, and if colon cancer is found, then start treatment early when it’s most curable.”