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Colon Cancer Awareness

Colorectal cancer is the second-leading cause of cancer related deaths in the U.S. Colorectal cancer is defined as cancer of the colon or rectum. Regular screenings can help prevent colorectal cancer through diagnosis at an early, curable stage and through removal of precancerous polyps. A polyp is an abnormal growth of tissue lining the colon or rectum; some polyps, such as an adenoma polyp, may turn into cancer or may already be cancer. Individuals with a personal history of colon polyps or family history of colon polyps /colon cancer are at an increased risk of developing polyps.

Colorectal cancer screening is safe and effective. Early detection of colorectal cancer leads to easier treatments and higher survival rates. There are several different options for screening, colonoscopy being the most common. Schedule an appointment to talk to your gastroenterologist to make an informed decision about which screening tests are right for you.

Along with regular screenings, healthy lifestyle choices are also good for colorectal cancer prevention.

  • Stop smoking
  • Exercise regularly (at least 30 minutes of exercise on most days)
  • Increase foods high in fiber (whole grains, fruits, vegetables)
  • Choose a variety of fruits and vegetables
  • Increase calcium intake (low-fat milk, shellfish, salmon, & calcium supplements vitamin D)
  • Decrease fats (oils, butter, red meats)
  • Maintain a healthy weight
  • Drink alcohol in moderation, if at all

People 50 years old or older, male or female, with no increased risk factors would be considered at average risk for colorectal cancer.  Increased risk factors include:

  • Personal history of colorectal cancer or adenomatous polyps
  • Family history of one or more parents, siblings, or children with colorectal cancer or adenomatous polyps
  • Family history of multiple cancers, involving the breast, ovary, uterus and other organs
  • Personal history of inflammatory bowel disease, such as ulcerative colitis or Crohn’s disease
  • Inherited syndromes, such as Familial Adenomatous Polyposis (FAP)
  • Lynch Syndrome

Colorectal cancer may begin with no symptoms at all.  The following signs or symptoms might indicate colorectal cancer:

  • Rectal bleeding or blood in your stool (bright red, black or very dark)
  • Weight loss without dieting
  • Constant fatigue
  • Unexplained anemia
  • Change in bowel habits
  • Change in the shape of the stool or narrower than normal stools
  • Discomfort during a bowel movement or the urge to move your bowels when there is no need
  • Cramping pain in your lower abdomen
  • Frequent gas pains

Cologuard® is not recommended as a replacement for colonoscopy by the physician at Midwest Gastrointestinal Associates (MGI).

Colorectal cancer is the second leading cause of cancer death in the US when men and women are combined.  It is estimated 1 in 3 adults ages 50-75 are not getting the recommended screening for colorectal cancer.  In Nebraska, only 68.7% of adults ages 50-75 years old are getting their recommended colorectal screening.

Cologuard® is marketed as convenient, noninvasive colon cancer screening test that you can use in the privacy of your own home.  However, this multi-targeted stool DNA test is a source of significant controversy amongst physicians.

Cologuard® markets they have 92% sensitivity for detecting colon cancer.  While this may not sound like a bad test, missing 8 out of every 100 cancers is actually a big deal!  Furthermore, the test is not very accurate – meaning most of the positive test results are actually FALSE positives.  In fact less than 4% of the patients who have a positive Cologuard test will have colon cancer found on colonoscopy!  For these reasons, Cologuard® is not recommended by several of the major medical societies.  If it is recommended as a screening option, it is a second-tier test, meaning colonoscopy is the preferred test.  Colonoscopy is still viewed as the gold standard (best test) for colon and rectal cancer detection and prevention.  Most importantly, colonoscopy is the only test that can actually prevent colon cancer by removing polyps before they become cancerous!

Why Detecting Polyps Matters

Colon polyps are growths in the colon which could potentially become colon cancer.  There are three types of screenings for colon polyps:

  1. Colonoscopy – 95% of large polyps detected
  2. Stool DNA (Cologuard®) – 42% of large polyps detected
  3. Fecal Immunochemical Test (FIT) – 30% of large polyps detected

Unfortunately, the majority of large polyps go undetected with stool tests (FIT and Cologuard®).

When polyps aren’t found and removed you are at risk for developing colon cancer.  Colonoscopy is the gold standard for finding polyps. If polyps are found during a colonoscopy, they are removed during the same single procedure.  This eliminates the need for additional procedures or tests.

If polyps are suspected through FIT or Cologuard®, a colonoscopy must be performed to remove the polyps.  Most insurance providers consider Cologuard® a screening exam which utilizes your preventative health benefit.  Once this benefit has been utilized, they will not cover an additional exam, such as colonoscopy, under preventative benefits.  In other words, you may want to think twice before submitting that stool sample because you may end up paying your deductible and coinsurance for a colonoscopy regardless!

Cologuard® Test: Detection Not Prevention

Cologuard® is designed to detect cancer not prevent it.  A stool test by itself cannot prevent cancer.  Cologuard® can only detect 42% of large polyps and the majority of large precancerous polyps cannot be detected. Cologuard® may give patients a false sense that they are preventing colon cancer by submitting a stool sample at home.

Cologuard® is NOT For Everyone

If you have a high risk of colorectal cancer, you should skip the Cologuard® test.  High risk factors include a family history of colon cancer, concerning symptoms or previous colonoscopy with polyps found.  This will save you time, money, and the frustration of undergoing both tests since a colonoscopy is needed for high risk patients.  In addition, patients with symptoms such as abdominal pain, changes in bowel habits, hemorrhoids or rectal bleeding should not submit a Cologuard® test as this decreases the accuracy of the test.

How Accurate are the non-invasive Stool Tests?

There are two types of stool tests for colon cancer:  Fecal Immunochemical Test (FIT) and Stool DNA (Cologuard®).  FIT detects 70% of colon cancers and 30% of large colorectal polyps. Stool DNA/Cologuard® detects 92% of cancers and 42% of large colorectal polyps.

Cologuard® is better at detecting cancer than FIT (92% vs 70% for FIT), but the false positive rate is higher.  Cologuard® has a 12% false positive rate, and that rate increases as people age.  However, Cologuard® is less accurate than a colonoscopy at detecting polyps of any size.

Can I use Cologuard® instead of a colonoscopy?

No.  Cologuard® is not designed to be a replacement for a colonoscopy, even though advertisements may suggest otherwise.  Dangerous precancerous polyps are not detected with Cologuard® 58% of the time which is significantly less effective than a colonoscopy. However, Cologuard® may be an option for some patients who insist on not getting a colonoscopy.  Even a 42% chance of detection is better than no detection at all.

What is the cost comparison between screening options?

The cost of Cologuard® is around $500.  Part of that cost may be covered by some insurance companies depending on your plan, co-pay, and deductible.  However, if the Cologuard® test is positive, then a colonoscopy will be needed.  A diagnostic colonoscopy is subject to deductibles and coinsurance.

Screening colonoscopy is not subject to copays and deductibles and usually has no out of pocket costs for patients.  For screening colonoscopy, most insurance companies offer screening benefits for those patients who are not at a high risk.

If you notice any symptoms of colon cancer, such as blood in your stool or a persistent change in bowel habits, make an appointment with your gastroenterologist to talk about your symptoms.

Compiled from the American Cancer Society’s Colorectal Cancer Facts & Figures 2011-2013.

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