Your health questions answered by Brown physicians
PHOTOGRAPHY : GETTY IMAGES / NATALI MIS ; BELOW : COURTESY OF BROWN PHYSICIANS , INC .
Are other colon cancer tests as reliable as a colonoscopy ?
Colorectal cancer is the second leading cause of cancer-related death in the US , according to the CDC . Regular screening — recommended for anyone aged 45 to 75 who ’ s at average risk — significantly reduces the chance of developing and dying from this preventable disease .
Colonoscopy gets the most hype because it ’ s a one-step process that is both diagnostic and therapeutic : if we find a polyp we can remove it there and then . I recommend it to my friends and family for this reason . The preparation has come a long way , and after the procedure almost all my patients say it was much easier than they had expected . But I do appreciate patients ’ concerns . Health care is expensive , people have to take time off , people in rural areas may have to travel a great distance to see a gastroenterologist . We need to be mindful of our entire population .
Fortunately , stool-based tests are equally effective at detecting and preventing colon cancer . FIT ( fecal immunochemical test ) is testing for the presence of blood ; Cologuard looks for the presence of blood and genetic mutations . Both tests are done at home and sent to a lab , which sends the results to the ordering physician . We call this two-step testing : if the first step is positive , you will then be referred for a colonoscopy . If it ’ s negative , FIT testing is repeated yearly , and Cologuard every three years . ( Colonoscopies are recommended every 10 years if no polyps are found .)
People with a strong family history of colon cancer or genetic syndromes that predispose them to polyps should probably forgo stool-based testing . For patients with inflammatory bowel disease , we do colonoscopies to make sure that inflammation over time doesn ’ t develop cancerous lesions . As of right now , there ’ s no reliable blood test for colon cancer screening .
Unfortunately , we don ’ t have enough gastroenterologists in the US to achieve a nationwide goal to screen 80 percent of patients using colonoscopy . Two-step testing is a way to screen more patients , and then , if needed , get them into a gastroenterologist for assessment and treatment . HD
Gastroenterologist Sean Fine , MD , MS , is the director of the Inflammatory Bowel Disease Center and assistant professor of medicine at Brown .
Brown Physicians , Inc . is a multispecialty group practice affiliated with The Warren Alpert Medical School of Brown University . BPI serves Rhode Island and southeastern Massachusetts with more than 500 primary care physicians and specialists to provide cutting-edge , team-based care . In each issue of Health Discoveries , we ’ ll ask BPI doctors common health care questions . If you have a question for our doctors , send it to HealthDiscoveries @ brown . edu .
WINTER 2023 l HEALTH DISCOVERIES 23