Here's a question for you. What good is a test if no one does it? The answer is obvious. And here's the problem. As good as colonoscopy testing is at finding colorectal cancer before it can kill you, only a fraction of the men and women who should be getting them actually get the procedure. In real numbers, that means a staggering 35 million Americans over the age of 50 who should have the test don't do it.
Colorectal cancer claims over 53,000 lives every year and is the second-leading cause of cancer death in the U.S. But when you detect and treat it early, it has a 90% cure rate. That means that if everyone did the colonoscopy that their doctors recommended, we could save over 45,000 lives every year. But they don't. Even though colonoscopy is still the screening test that most doctors rely on for the early detection of colorectal cancer, a full 62% of patients fail to do it within a year of a physician recommending the procedure. And I'm right in that group. My last colonoscopy was 11 years ago. You're supposed to get them every five to ten years. So, why am I and so many others so tardy?
There are several reasons. First of all, getting a colonoscopy means having to take one to two days off for the procedure. And then you have to prep yourself with a bowel cleaning procedure that's going to give you runny diarrhea for 24 hours. Then, you're going to be put to sleep during the procedure, which means that you're not going to be able to drive home. And if that's not enough, there are risks. Although, the risks are small, about 25 in every 10,000 procedures, they can be significant and even life threatening. So, is there a better way? I think so. It's called Cologuard.
I've written about Cologuard in the past. And here's why I think it's a better way to go than colonoscopy. With Cologuard, you can do the test at home. You don't need to take one to two days off work and go to a doctor's clinic like you do with a colonoscopy. Second, you don't need to go give yourself diarrhea and go through the whole bowel cleaning procedure. All you do is collect a stool sample at home and mail it in to the laboratory. Third, there are no risks. It's 100% safe. And fourth, and most importantly, the latest statistics show it to be just as sensitive as colonoscopy at finding early cancers.
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Cologuard is not just one of those tests that looks at whether or not there's blood in the stool. These tests will typically miss an early colorectal cancer more than half the time. Instead, the test analyzes a number of genetic markers that are in the stool when colorectal cancer is present. The likelihood that a colonoscopy will find an early colorectal cancer is 95%. It's going to miss one about 5% of the time. And Cologuard is right in there.
In a clinical study published in 2014 that included more than 90 sites throughout the U.S. and Canada, Cologuard's stool DNA technology was evaluated in 10,000 participants. That study showed that Cologuard was able to find early colorectal cancers 94% of the time - every bit as good as colonoscopy without any of the aggravation.
But Cologuard is not for everyone. Individuals who have a history of colon cancer or polyps, have been diagnosed with a condition such as irritable bowel syndrome or Crohn's disease, or have certain hereditary conditions are not appropriate candidates for Cologuard. But, if you're like me and don't have any of these problems and are resisting colonoscopy, talk with your doctor about Cologuard testing.
If you do have the conditions mentioned above, you're even at greater risk for colorectal cancer than the general population. So please bite the bullet and get the procedure before it's too late. I hope that none of my readers ever end up in that group of patients who refuse all testing and then discover they have a serious problem that was 90%+ preventable.
Yours for better health,
Frank Shallenberger, MD
Imperiale TF, Ransohoff DF, et al. Multitarget Stool DNA Testing for Colorectal-Cancer Screening N Engl J Med
2014; 370:1287-1297April 3, 2014.