Alternatives to colonoscopy may help beat "fear of the rear"

Thomas Johnson, MD

Posted September 14, 2015

The thought of getting cancer is scary; however, for many, the thought of getting a colonoscopy is almost as terrifying. One-third of Americans over the age of 50 have never been screened, even though colon cancer is highly treatable when caught early. The "fear of the rear" has contributed to colon cancer being the third leading cause of cancer deaths in the U.S.

Fortunately, a colonoscopy—although still considered the gold standard for screening—is no longer the only option.

The newest alternative for people who may have been putting off a colonoscopy, and who aren't at particular risk for colon cancer, is a stool DNA test. With this test, a person collects a single stool sample at home using a kit, mails it to the test lab and gets the results back in a few days from his or her doctor. Initial research suggests 92 percent accuracy.

While it is encouraging that there are alternatives to colonoscopy, it's also important to recognize that fear often stems from the unknown. Understanding what to expect before, during and after a colonoscopy can help demystify the procedure and reduce anxiety. Whether you choose a colonoscopy or an alternative, the key is to get screened. Colon cancer is one of the most preventable cancers when caught early and being proactive about your health starts with knowledge.

To help understand screening alternatives, I've summarized some of the pros and cons of each in the table below. As the old saying goes, the best screening test is the one that people will actually use.

Type of test	Pluses	Minuses
Colonoscopy Accuracy: About 93 percent Cost: Expensive, but covered by insurance Risk: Low risk of bleeding, bowel perforation or infection Frequency: Once every 10 years, or as determined by your physician	+ surgeon can view entire colon + polyps can be removed and biopsied during procedure + can diagnose other diseases	- requires special pre-test diet and bowel preparation - sedation means you may miss a day of work
Stool DNA test (e.g. Cologuard^®) Accuracy: About 92 percent, but may miss many polyps and some cancers; may produce false positive Cost: about $500-$600; covered by Medicare; some other insurance programs do not yet cover Risk: No direct risk to bowel Frequency: Once every three years	+ sampling performed at home + no diet restrictions before test + non-invasive	- if abnormal, will require a colonoscopy
Fecal immuno-chemical test (FIT) Accuracy: about 74 percent, but may miss many polyps and some cancers; may produce false positives Cost: Relatively inexpensive Risk: No direct risk to bowel Frequency: once a year; a flexible sigmoidoscopy procedure should also be performed once every five years	+ sampling performed at home + no diet restrictions before test + non-invasive	- if abnormal, will require a colonoscopy
Fecal occult blood test (FOBT) Accuracy: Least accurate but better than no screening; may miss many polyps and some cancers; may produce false positives Cost: Inexpensive Risk: No direct risk to bowel Frequency: once a year; a flexible sigmoidoscopy procedure should also be performed once every five years	+ sampling performed at home + non-invasive + restricted diet before test	- if abnormal, will require a colonoscopy

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Alternatives to colonoscopy may help beat "fear of the rear"

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