When it comes to colon cancer, the most popular strategy for screening is the colonoscopy, which involves a nearly 24-hour commitment to the prep for the invasive and uncomfortable procedure. The benefit of enduring the screening, as doctors tell us, is that if it finds suspicious polyps, the colonoscopy can remove them at the same time. Plus, for most people it’s just a once-in-every-10-years ordeal.
It’s not the only way to screen for colon cancer, but it has become the default choice. This, despite the fact that no rigorous studies have shown that colonoscopy screening can actually lead to fewer deaths from colon cancer; medical organizations that include colonoscopies in their screening options have based their advice on the fact that detecting and removing polyps must logically lower incidence, and therefore death, from the disease.
But in an editorial published in the Annals of Internal Medicine, Dr. David Weinberg, chairman of medicine at the Fox Chase Cancer Center, and his colleagues argue that fecal testing is just as effective as colonoscopy in detecting lesions that are potential colon cancers.
Weinberg addresses concerns over the emergence of colonoscopy as the default, pointing out that many people are uncomfortable with the procedure, and that globally, not every country can afford the test for every citizen beyond middle age. Even in the U.S., where the use of colonoscopy is high, access to the procedure isn’t uniform.
“From the patient’s perspective, the American health establishment prefers colonoscopy; I do think that’s probably true,” says Weinberg. That means people who aren’t comfortable with the procedure might not get screened for colon cancer at all.
That’s why Weinberg and his colleagues want to alert physicians and patients to the fact that alternatives do exist, including the fecal immunochemical test, which involves sending a sample of feces in a special kit to a lab for testing. The fecal test picks up signs of blood, which can be an indication that a tumor is present.
While effective at triaging people who might have growths from those with negative tests who don’t, the fecal test requires yearly updates and means the physician has to follow up with the patient to make sure the test was done and then communicate the results when they arrive from the lab.
The added work has made the once-in-10-years colonoscopy more attractive to many primary-care doctors, but Weinberg argues that if some people are bypassing screening altogether because they aren’t enamored with the colonoscopy, then doctors should be offering them the fecal testing so they don’t miss screening for the cancer altogether.
“Really the physician should be saying okay, there are differences between fecal testing and colonoscopy and we can talk about them if you want to. What I really care about most is that you do one of them,” says Weinberg. “The only thing that is unacceptable in my perspective is that you don’t do anything.”
That means it’s up to doctors and patients to decide whether they prefer to give up one day for an invasive procedure, or to follow up yearly with fecal testing to screen for colon cancer. It’s a matter of personal choice, says Weinberg, since the science shows that either strategy is equally effective at lowering risk of the disease.
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