Colon cancer screening: Weighing the options

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Colon cancer screening: Weighing the options

If your doctor has recommended colon cancer screening, you may be able to choose from various colon cancer screening tests. If you're reluctant to make a decision, remember that any discomfort or embarrassment from colon cancer screening is temporary — and detecting problems early may save your life. To help choose the colon cancer screening test that's best for you, consider the following questions.

What preparation is involved?

Preparing for colon cancer screening can be uncomfortable or inconvenient, but it's necessary for the test to be effective. As part of your decision, consider your willingness or ability to follow the preparation instructions for specific colon cancer screening tests. This may — to varying degrees — include avoiding solid food the day before the exam, adjusting your medications, and using laxatives or enemas to empty your colon.

How convenient is the test?

In addition to test preparation, consider:

  • How long the test will take
  • How often you need to repeat the test
  • Whether you'll need sedation, which may mean that you can't drive for up to a day
  • The possible need for follow-up testing to investigate a false-positive finding or to remove or biopsy tissue

What about cost and insurance issues?

Find out how much each colon cancer screening test costs, as well as which tests your insurance company covers. Are you willing to pay out-of-pocket if necessary?

What is your attitude toward screening tests?

The more thorough the colon cancer screening test, the more likely it is to detect any cancer or precancerous polyps. Conversely, a more thorough test may also mean more inconvenient or uncomfortable preparation, a slightly higher risk of serious complications, or both. Think about your approach to screening tests and what's most important to you. Will you feel best if you know you've chosen the most thorough screening test possible? Will you worry or doubt the results if you choose a less thorough test? How concerned are you about convenience, preparation or the possibility of serious complications?

What is your doctor's approach to screening tests?

Make sure that you're comfortable with the colon cancer screening test your doctor recommends. If your doctor specializes in a particular test but you'd rather have another test, express your wishes. If necessary, your doctor may offer a referral to someone trained in the test with which you feel most comfortable.

What is your risk level?

Your risk of colon cancer may influence your choice of screening tests. For example, your doctor may recommend colonoscopy as the screening tool of choice, likely at frequent intervals, if you:

  • Have a personal history of colon cancer or precancerous polyps
  • Have a parent, sibling or child who's had colon cancer
  • Carry a gene for a hereditary colon cancer syndrome
  • Have a history of inflammatory bowel disease, such as ulcerative colitis or Crohn's disease

What are the pros and cons of each test?

Here's an overview of the most common colon cancer screening tests.

Colonoscopy
A colonoscopy is an exam used to detect changes or abnormalities in the large intestine and rectum. A long, flexible tube (colonoscope) is inserted into the rectum. A tiny video camera at the tip of the tube allows the doctor to view the inside of the entire colon.

  • Pros: Colonoscopy is considered the gold standard for colon cancer screening. Polyps or other types of abnormal tissue can be removed through the scope during the exam. Tissue samples (biopsies) can be taken as well. The exam takes 20 minutes to an hour.
  • Cons: The test may not detect all small polyps and cancers. You may need to adjust your usual medications before the exam. Solid food can't be eaten the day before the exam. Emptying the colon with laxatives, enemas or both can be unpleasant. Sedation is recommended. Rare complications may include an adverse reaction to the sedative, bleeding from the site where a biopsy was taken or a polyp or other abnormal tissue was removed, or a tear in the colon or rectum wall. It may take a day for the sedative to wear off. Bloating may occur for a few hours after the exam.

Virtual colonoscopy
A virtual colonoscopy (computerized tomography colonography) is an exam used to detect changes or abnormalities in the large intestine and rectum. A catheter is placed inside the rectum to fill the colon with air or carbon dioxide. Computerized tomography (CT) is used to produce cross-sectional images of the abdominal organs.

  • Pros: Unlike traditional colonoscopy, virtual colonoscopy doesn't require sedation or the insertion of a scope into the colon. The exam takes about 10 minutes.
  • Cons: The test may not detect all small polyps and cancers. You may need to adjust your usual medications before the exam. Solid food can't be eaten the day before the exam. Emptying the colon with laxatives, enemas or both can be unpleasant. An adverse reaction to the contrast agent sometimes used during virtual colonoscopy is possible. Radiation exposure may be a concern. Biopsies can't be performed during the procedure. If an abnormality is detected, a colonoscopy may be necessary. Bloating may occur for a few hours after the exam. Many doctors consider virtual colonoscopy experimental.

Fecal occult blood test
A fecal occult blood test is a lab test used to check stool samples for hidden (occult) blood.

  • Pros: Stool sample collection can be done at home. There's no need to empty the colon ahead of time.
  • Cons: The test fails to detect most polyps and some cancers. Certain foods and medications must be avoided for three days before the test. If blood is detected, additional tests may be needed to determine the source. False-negative and false-positive results are possible.

Flexible sigmoidoscopy
A flexible sigmoidoscopy is an exam used to evaluate the lower part of the colon. A thin, flexible tube (sigmoidoscope) is inserted into the rectum. A tiny video camera at the tip of the tube allows the doctor to view the inside of the rectum and most of the sigmoid colon.

  • Pros: Sedation isn't required. Biopsies can be taken through the scope during the exam. The exam takes about 15 minutes.
  • Cons: You may need to adjust your usual medications before the exam. Solid food can't be eaten the day before the exam. Emptying the colon with laxatives, enemas or both can be unpleasant. The exam doesn't allow the doctor to see the entire colon. Rare complications may include bleeding from the biopsy site or a tear in the lining of the colon. Bloating may occur for a few hours after the exam. Additional tests may be necessary if an abnormality is detected.

What's the bottom line?

Choosing a colon cancer screening test isn't always an easy decision, but it's a potentially lifesaving one. Consult your doctor about your colon cancer screening options. Whatever your choice, remember that some screening is better than no screening.

Last Updated: 2010-10-21
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