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Colonoscopy Alternatives: Pros and Cons

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    Colonoscopy Alternatives: Pros and Cons

    The second leading cause of cancer deaths in the United States for both men and women is colon or colorectal cancer. Colon cancer is also one of the most treatable forms of cancer if detected early. Millions of lives have been saved each year due to colorectal cancer screening tests that can detect premalignant tissue growths known as polyps. Unfortunately, according to the CDC (Centers for Disease Control and Prevention), 1 in 3 adults between the ages of 50 to 75 are not getting screening for colorectal cancer every year. Why?

    Many adults are not aware that they need to be screened for colorectal cancer and others avoid the screening because they are wary of a colonoscopy – the preferred method to screen for colorectal cancer. When people are given different options to test for colorectal cancer they are more likely to follow through with the screening. There are several alternative options to a colonoscopy that are effective in detecting colorectal cancer cells early. Each has their own advantages and disadvantages when comparing:

    • Price
    • Invasiveness
    • Complications and recovery
    • Accuracy in detecting and diagnosing cancer 

     Virtual Colonoscopy (CT colonography)

    Also called CT (computerized tomography) colonography, a virtual colonoscopy uses a CT scanner to capture images of the colon and rectum. In this imaging  procedure, a radiologist examines your rectum and colon from outside of your body with the use of x-rays and a computer. By looking at the images from several different angles, the radiologist can identify ulcers, polyps, and even cancer. A virtual colonoscopy is more cost-effective , less time-consuming, and less invasive than a colonoscopy. However, if a polyp is found during the imaging appointment, you will need to have a colonoscopy to have it removed. 

    Pros

    • The screening usually takes from 10 to 15 minutes 
    • The procedure is completely external with no colonoscopy used during screening
    • A patient requires no sedation for x-ray
    • A patient can  immediately return to normal activities after a virtual colonoscopy
    • The screening has a very low risk of causing a perforation, or tearing of the intestinal lining

    Cons

    • Less sensitive than a colonoscopy for finding smaller polyps
    • If you need a polyp removed or a biopsy, you have to have a colonoscopy
    • Not all insurance providers will cover a virtual colonoscopy
    • Requires a bowel cleanse to prepare for the test (the same as a colonoscopy)

    Price: $250-$500

    Invasiveness: Noninvasive but requires bowel preparation

    Complications and Recovery: Low risk of complications and recovery simply is eating a good meal. Your doctor will inflate your colon with air before taking the xray. There is a small  risk with the inflation that a perforation (tear or hole) may occur in the lining of the large intestine. 

    Accuracy and ability to diagnose: 90% effective in finding larger tumors and 65% effective at detecting tumors measuring ½ centimeter or larger 

    Double-contrast Barium Enema

    Like the virtual colonoscopy, a double-contrast barium enema uses X-rays to identify abnormal tissue in the lining of the colon. Barium is a silver-white metallic compound that is coated along the walls of the intestinal lining to assist visualization of the colon and rectum with the use of an enema tube. After the large intestine is coated with the barium, air is passed into the colon through the rectum to inflate the colon to enhance imaging. The physician will take x-rays from several different angles of the colon as the barium and air fill the intestine to help identify abnormalities, such as polyps, abnormal tissues, and lesions. 

    Pros

    • Less expensive than a colonoscopy
    • Can identify colorectal cancer in its earliest stage
    • Can be performed without sedation
    • Carries a low risk for perforation
    • Effective method for finding polyps, abnormalities, and narrowed sections in the intestinal wall
    • Helps identify lesions in all sections of the colon
    • Many insurance plans cover the cost of procedure

    Cons

    • Typically only available to people who cannot get a colonoscopy
    • Can be an uncomfortable procedure for some people
    • Requires the use of radiation (x-ray)
    • If you need a polyp removed or a biopsy, you have to have a colonoscopy
    • Requires a bowel cleanse to prepare for the test (the same as a colonoscopy)

    Price: $200-$1000

    Invasiveness: Moderate

    Complications and Recovery: Low risk for perforation and a faster recovery than a colonoscopy due to no sedation needed

    Accuracy and ability to diagnose: Less sensitive than colonoscopy in detecting polyps and tumors

    Take-home Fecal Tests

    Fecal immunochemical testing (FIT)

    FIT uses antibodies to detect the blood protein globin found in hemoglobin. These tests are designed to detect specifically human globin proteins and will not react with blood proteins from non-human blood that is found in red meats. People who take the FIT to screen for colorectal cancer do not need to avoid red meats and other foods or medications before they take the test. 

    Pros

    • Detects hidden blood to identify the presence of abnormal tissue, polyps, or colorectal cancer
    • Noninvasive and requires no sedation or anesthesia
    • No bowel preparation needed
    • Most insurance companies cover the cost of FIT
    • Test is done at home requiring a simple stool collection

    Cons

    • You will need additional tests if blood is found, including a colonoscopy
    • The test may fail to detect small polyps and cancer
    • May require restricted diet and avoiding medications a few days before stool sample collection
    • Does not examine the entire colon
    • A colonoscopy is required If there are polyps found 
    • Tests need to be done every year

    Price: $20

    Invasiveness: Noninvasive

    Complications and recovery: Very low risk for complication and no recovery time

    Accuracy and ability to diagnose: Detects nearly 80% of colon cancers. There are false negative and false positive results returned to some patients. 

    Fecal occult blood testing (FOBT)

    Like FIT, this test checks your stool for occult blood, or blood you cannot see by looking at your stool. In this test, you need to collect stool samples for 3 consecutive days. The reason for this is to increase the possibility of finding blood, as the bleeding may not be occuring every day. The FOBT does have food, supplement, and medication restrictions. 

    Pros

    • Detects colorectal cancer at an early stage when it is highly treatable
    • Requires no bowel cleansing
    • Test is done at home with the collection of a stool sample
    • Cost of test is affordable which benefits people without health insurance
    • Noninvasive and there is no need for sedation or anesthesia
    • Detects hidden blood in the stool to help with the diagnosis of a type of anemia caused by blood loss in the digestive tract
    • Test is covered by many insurance companies
    • People without health insurance will find the screening costs less than a colonoscopy

    Cons

    • May fail to detect benign tumors and small  polyps
    • If blood is found in the stool you will still need a colonoscopy
    • Requires you to avoid certain foods and medications
    • Some people receive false positive results which requires a colonoscopy
    • Some people receive false negative results that miss possible cancers and precancerous polyps

    Price: $25

    Invasiveness: Noninvasive

    Complications and recovery: Very low risk for complication and no recovery time

    Accuracy and ability to diagnose: 71%-95% effective in detecting cancer cells

    Cologuard

    The Cologuard home colon cancer screening test detects cancer by identifying DNA markers and occult blood in stool samples. You are not required to change your diet or medications before this test. Once you collect a sample of your stool, you will send or drop off your sample to a lab. The lab will return the results to your physician or healthcare provider who will contact you as soon as they arrive. 

    Pros

    • Highly sensitive for the detection colon cancer in its earliest stages and larger-sized polyps
    • Test is performed in the comfort of your own home
    • No bowel cleansing or preparation is needed
    • For uninsured people, the test is cheaper than getting a colonoscopy
    • Many insurance companies cover the cost
    • Noninvasive
    • No sedation is needed

    Cons

    • A colonoscopy is still needed if there are polyps found
    • Unavailable to higher-than-average risk patients
    • A significant number of people (13%)  receive false positive results
    • 8% of colon cancer cases are missed due to a false negative result
    • Does not examine the entire colon
    • You need to repeat the test every three years

    Price:$500-$600

    Invasiveness: Noninvasive

    Complications and recovery: Very low risk for complication and no recovery time

    Accuracy and ability to diagnose: Detects 92% of colorectal cancers

    Sigmoidoscopy

    In a sigmoidoscopy, a physician examines the rectum and the distal or “left” side of the colon, using a flexible tube with a camera equipped on one end. A sigmoidoscopy is cheaper and less invasive than a colonoscopy but does reach the proximal or “right” side of the colon. Because a sigmoidoscopy only examines the lower section of the colon, the procedure takes much less time and patients usually choose to not be sedated. If the examining physician finds a polyp or abnormal tissue in the sigmoid they will promptly remove the polyp and test the tissue for malignancy. 

    Pros

    • Easier bowel preparation than a colonoscopy
    • Less invasive than a colonoscopy which uses a longer instrument to examine the entire colon
    • Can be performed without sedation
    • Helps doctors rule out causes of abdominal pain, rectal bleeding, and other abdominal problems
    • Takes a significantly shorter amount of time than a colonoscopy (10-20 minutes)
    • Lower risk of perforation than a colonoscopy
    • Detects polyps and  cancer in the last segment of the colon 
    • Polyps and abnormal tissue can be removed during sigmoidoscopy

    Cons

    • Requires a bowel cleanse and some dietary modifications the day before procedure
    • Fails to detect cancer in the upper sections of the colon
    • Patients may have discomfort after sigmoidoscopy, such as bloating and abdominal pain 
    • HIgher risk of complications compared to at home cancer screening tests
    • Test is recommended every five years

    Price $200 -$300

    Invasiveness Moderate 

    Complications and Recovery

    Accuracy and Ability to Diagnose 

    References

    Centers of Disease Control and Prevention. (2013, November 05). Colorectal cancer tests save lives. Retrieved from CDC Vital Signs: https://www.cdc.gov/vitalsigns/colorectalcancerscreening/index.html#problem

    Fletcher, J. (2020, June 04). 7 alternatives to a colonoscopy. Retrieved from Medical News Today: https://www.medicalnewstoday.com/articles/320132

    Mayo Clinic Staff. (2020, May 06). Flexible sigmoidoscopy. Retrieved from Mayo Clinic: https://www.mayoclinic.org/tests-procedures/flexible-sigmoidoscopy/about/pac-20394189

    National Institutes of Health. (2008, September). Virtual colonoscopies rival accuracy of standard ones. Retrieved from NIH: https://www.nih.gov/news-events/nih-research-matters/virtual-colonoscopies-rival-accuracy-standard-ones

    Nemo, L. (2021, March 25). How at-home colorectal cancer screening tests compare to coloscopies. Retrieved from Discover Magazine: https://www.discovermagazine.com/health/how-at-home-colorectal-cancer-screening-tests-compare-to-colonoscopies

    Norton Healthcare. (2020, October 06) Is an at-home colon cancer test right for? Retrieved from Norton Healthcare: https://nortonhealthcare.com/news/at-home-colon-cancer-test/

    Pickhardt, P. J. (2007, August). Screening CT Colonography: How I do it. American Journal of Roentgenology, 189, 290-298. Retrieved from AJR Online: https://www.ajronline.org/doi/pdf/10.2214/AJR.07.2136

    Ramdzan, A. R., et., al. () Diagnostic accuracy of FOBT and colorectal cancer genetic testing: A systematic review & meta-analysis. Annals of Global Health, 70. Retrieved from Annals of Global Health: https://annalsofglobalhealth.org/articles/10.5334/aogh.2466/