Dreading a colonoscopy? There are alternatives

Dear Savvy Senior,

Are there any easier alternatives to a colonoscopy to screen for colon cancer? I just turned 60 and my wife keeps nagging me to get tested, but I hate the idea of drinking that laxative solution and being sedated for the procedure.

— Squeamish Steven

Dear Steven,

While a colonoscopy remains the most accurate screening test for detecting colon cancer (94 percent accurate), there are other easier – although less accurate – tests available. But be aware that if the result of one of these tests are positive, you’ll still need to undergo a colonoscopy. Here’s what you should know.
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Screening Guidelines

Colorectal cancer, which develops slowly over several years without causing symptoms especially in the early stages, is the second largest cancer killer in the U.S., claiming more than 50,000 Americans each year.

Colorectal cancer screening guidelines from the U.S. Preventive Services Taskforce and the American Cancer Society call for most adults to get screened starting at age 45 and continuing through age 75. Earlier screenings, however, are recommended to people who have an increased risk due to family history of colorectal cancer or polyps, or a personal history of inflammatory bowel disease, Crohn’s disease or ulcerative colitis.

But despite these guidelines, and the fact that colonoscopies save an estimated 20,000 U.S. lives each year, around 40 percent of eligible people don’t get screened.

Why? Because most people, like yourself, dread the laxative prep and sedation, not to mention the procedure itself.

But a colonoscopy is not your only option for screening for colon cancer. There are currently several types of FDA approved stool tests that you can take in the privacy of your own home that requires no laxative-taking/bowel-cleansing preparation. The two most accurate that you should ask your doctor about are the:

Fecal immunochemical test (FIT): This test looks for hidden blood in your stool, which suggests polyps or even cancer. Your doctor will give you a FIT test kit to use at home. You take a small sample of stool and mail it to a lab to be analyzed. You don’t need to do any prep. The cost of this annual test is covered by private insurance and Medicare. FIT has an almost 80 percent accuracy rate for detecting colon cancer, but it detects only about 28 percent of advanced polyps that might turn into cancer.

Stool DNA test (Cologuard): This screening kit looks for hidden blood as well as altered DNA in your stool. Your doctor will order the test, and you will receive the collection kit in the mail. You do the test at home every three years and send your stool samples to Cologuard via UPS. No special prep or change to your diet or medication schedule is required. Cologuard, which is covered by most private insurers and Medicare, detects 92 percent of colon cancers but only 42 percent of large precancerous polyps. It also may provide a false-positive, indicating that you might have cancer when you don’t.

New Blood Test

There’s also a new experimental colon cancer blood test you should ask your doctor about called the “Shield blood test.” This new test, developed by Guardant Health, detects more than 80 percent of colon cancers early when they’re most treatable.

Guardant is currently seeking FDA approval to market the test but it’s available now as a “lab-based test” (which does not require FDA approval) but it’s currently not covered by most private insurers or Medicare. Your doctor will need to request this test, which costs $895, at BloodBasedScreening.com.

Send your senior questions to: Savvy Senior, P.O. Box 5443, Norman, OK 73070, or visit SavvySenior.org. Jim Miller is a contributor to the NBC Today show and author of “The Savvy Senior” book.