Options for Colorectal Cancer Screening: Advantages and Disadvantages

Colorectal cancer is the third most common cancer diagnosed in the U.S. and the second leading cause of cancer related deaths. In fact, the American Cancer Society estimates that colorectal cancer will be the cause of 50,630 deaths in 2018.

The good news is that colorectal cancer can be prevented, and it is highly curable when detected in its earliest stages. In order to prevent and detect colorectal cancer, however, it’s important to get regular screenings. Preventive screenings are a powerful weapon against cancer, especially colorectal cancer.

Most people should start screening at age 50. Some factors, like family history or the presence of other gastrointestinal conditions, may require you to start screening earlier. Talk with your doctor about when you should start getting screened.

What are my options for colorectal cancer screening?

Option 1: Colonoscopy

Colonoscopy is the most effective method for detecting colorectal cancer and removing polyps. Gastroenterologists consider this method to be the gold standard, and research suggests colonoscopies can reduce colon cancer deaths by approximately 60 to 70 percent. During a colonoscopy, your doctor will examine the rectum and colon using a long, thin, lighted tube. If polyps are found during the procedure, they can also be removed.

Advantages	Disadvantages
Colonoscopy allows your doctor to view the rectum and the entire colon Your doctor can perform a biopsy or remove polyps if needed Colonoscopies are usually only performed every 10 years if you do not show signs of colorectal cancer	A bowel cleanse and dietary restrictions are required to perform the procedure The procedure is usually performed under sedation Although the test is highly sensitive, some small polyps may be missed

Option 2: Stool Tests

Stool tests include fecal occult blood tests (FOBT), fecal immunochemical tests (FIT) and stool DNA tests (FIT-DNA). These tests look for blood in the stool, as it can be an indicator of cancer. These tests are not as effective in preventing colorectal cancer deaths.

Advantages	Disadvantages
No bowel prep is required There is no risk of damaging the lining of the colon Samples can be collected at home without sedation	These tests can produce false-positive results Some polyps and cancers may be missed using this test If cancer is found, colonoscopy is needed anyway

Option 3: Flexible Sigmoidoscopy

Similar to a colonoscopy, this test uses a thin, lighted tube called a sigmoidoscope to examine the rectum and colon. Sigmoidoscopes are not long enough to allow your doctor to view all of the colon, however, and this test is not often used as a screening procedure in the United States.

Advantages	Disadvantages
Sedation is not often required Doctors may be able to perform a biopsy or remove a polyp The procedure is fairly quick	Your doctor is unable to see your whole colon and may not detect or remove all polyps Colonoscopy is still needed if cancer is detected

Option 4: CT Colonography (Virtual Colonoscopy)

This test uses CT imaging technology to produce detailed images of the colon. It is a non-invasive procedure and can be useful for people who do not want a test as invasive as a colonoscopy, but it cannot remove polyps if they are present. It is not yet known whether CT colonography is effective in reducing colorectal cancer deaths.

Advantages	Disadvantages
No sedation is needed The test is minimally invasive Usually allows doctors to see the whole colon	Bowel prep is still required Polyps cannot be removed if present and a colonoscopy will be necessary This test is still new and most insurances do not cover it

How much does screening cost?

Most insurances cover the cost of colorectal cancer screening, but they may restrict the type of screenings that are covered. Talk with your insurance provider to determine your coverage of colorectal cancer screening and consider this when making screening decisions with your doctor. Colonoscopy is almost always the most recommended screening.

Patients with high deductible plans may find that they need to pay an out-of-pocket cost, but the cost of screening is well worth the savings in the future if your screening colonoscopy results in a diagnosis. In 2013, the average cost of stage 1 colorectal cancer was estimated to be $49,189 per patient, and it continually increased with each stage. Prevention, early detection and early treatment can eliminate or significantly reduce healthcare costs associated with colorectal cancer.

If you are over 50, or have a family history of colon cancer, visit your gastroenterologist to discuss screening.

Revere Health’s experienced gastroenterology professionals offer comprehensive prevention, diagnosis and treatment of digestive disorders. We will work with you to develop a treatment plan based on your individual needs and goals.

Sources:

https://www.cancer.org/cancer/colon-rectal-cancer/about.html

https://www.cancer.gov/types/colorectal/screening-fact-sheet#q3

https://www.cdc.gov/cancer/colorectal/basic_info/screening/tests.htm

https://www.cancer.org/cancer/colon-rectal-cancer/detection-diagnosis-staging/screening-tests-used.html