Some of us are getting closer each year to the magical age when we will have to have the procedure. A colonoscopy helps check for and treat precancerous or cancerous polyps. Although the procedure itself isn’t unpleasant, the preparation and colon cleanse are anything but pleasant.

With the array of use at-home products available in the market, including pulse oximeters and home pregnancy tests, shouldn’t there be an option to screen for colorectal cancer at home?

There are existing home tests that doctors can recommend to patients at average risk. These fecal immunochemical testing (FIT) kits that can be delivered to your home come with instructions and materials for taking a small stool sample and sending it to a laboratory.

An average risk patient is someone who has not had precancerous polyps before and has no significant family history of colon cancer [a first-degree relative diagnosed under 60 years old]. Some diseases can predispose colorectal cancer such as inflammatory bowel disease and primary sclerosing cholangitis [a disease of the bile ducts], it is important to note that your patient does not suffer from any such condition.

While home testing is certainly a better option than no testing it has its limitations. While home testing is primarily used to detect cancer, early cancers, or large bleeding polyps a  colonoscopy is a thorough procedure that enables your specialist to not only detect cancer but also prevent it by excising any existing polyps that could become cancerous if left untreated.  

Why is it important to screen for colorectal cancer

Colorectal cancer, a form of cancer that starts in the colon or rectum, is the third most prevalent type of cancer and the third leading cause of death in the United States.

It used to be something that only the elderly needed to be concerned about. However, things are changing for the worse the American Cancer Society estimates that colorectal cancer will affect approximately 18,000 Americans under 50 this year. This is 12% of all cases. More than 3,600 of these patients are expected to die.

Dr. Mongiu from Yale explains that colon cancers take 7-10 years to progress from a polyp to cancer. This highlights the importance of screening early to detect disease when it is less likely to spread.

It is crucial to detect it in young people cause according to recent research millennials are at an increased risk of colorectal cancer. The American Cancer Society published the most comprehensive analysis of the trend in the Journal of the National Cancer Institute. People born in 1990, who would have been 31 years old this year, had a doubled risk of developing colon cancer and a quadruple risk of rectal cancer when compared with people born around 1950. This highlights the importance of increasing awareness and screening for colorectal cancer.

What is a colonoscopy?

 A colonoscopy is considered the gold standard screening method for colorectal cancers. Here’s how it works: You will be following a clear liquid diet the day before your procedure. At night, you will drink half of a laxative to cleanse your bowels. The other half will be finished in the morning four hours prior to the colonoscopy. (Procedure details may vary from lab to lab). On the day of your procedure, you will need to find a volunteer driver to take you home. You will not be allowed to drive after the procedure due to the anesthesia.

A tube known as a colonoscope is inserted into your rectum. The tube is equipped with a camera and light at its end that can display images for the doctor. The aim is to find existing polyps and remove them. If a polyp is removed it is sent to the pathology lab for further investigations. The procedure usually takes 30 to 60 minutes and should be repeated every 10 years.

Colonoscopy is one of the most common gastrointestinal procedures in the U.S. It has a high detection rate of colorectal carcinoma. A review of multiple studies showed a 69% reduction in overall colorectal incidence and 68% reduction in colorectal mortality associated with screening colonoscopy according to the American College of Gastroenterology (ACG).

What age should I be first screened? 45 or 50?

According to The United States Preventive Services Task Force, screening should be initiated at 45, rather than 50, and continued until 75. The revised guidelines are published in JAMA.

This is in line with other professional organizations such as the American Cancer Society which has its own recommendations. In 2018, they reduced their recommended age to 45 for those at average risk of developing colorectal carcinoma. Different recommendations may be followed by different hospitals, individual providers, and insurance companies. Discuss with your doctor when your first colonoscopy should be performed.

There are two types of home testing

You may be able to use home tests if you do not have a high risk of colorectal cancer and are hesitant about having a colonoscopy. There are two types of at-home testing. Neither one requires any dietary restrictions or drug restrictions, nor does it require special preparation.  

FIT Test

The fecal immunochemical test is the home test mentioned above. The boxed test comes with  instructions and equipment to take a stool sample which needs to be smeared onto the card included in the kit for processing. FIT can detect tiny amounts of blood which could indicate early signs of cancer. The test will be repeated every year if the results are normal. Your doctor will ask you to schedule a colonoscopy if blood is detected in your stool.

Test FIT-DNA

A stool DNA test, also called FIT-DNA, is another newer type of home test. It detects DNA mutations and blood in the stool that could indicate cancerous or pre-cancerous cells.

FIT-DNA is a test that uses stool samples that are screened. You will receive a kit by mail to help you collect your stool sample. This can then be mailed to a laboratory. A colonoscopy is required if the test detects DNA changes or blood. You can have the screening repeated every three years if the results are negative. These tests require a stool sample rather than a smear. The stool is packed on ice and returned to the company within one day of collection.  

New guidelines support stool DNA testing every 3 years for patients who are unable to or unwilling to have a colonoscopy. However, not all insurance companies will cover it. The FIT-DNA test has not been long-term tested for its role in reducing the incidence and mortality of colorectal carcinoma. However, it has been shown that it has a higher sensitivity (meaning it is more likely to detect) large serrated lesions and advanced adenomas than FIT.

What is the best option for me?  

Once you turn a certain age, colorectal cancer screening should become part of your routine screening. Discuss your options with your doctor before deciding which screening option is best for you. People might not have to do colonoscopy every ten years because of the stigma attached to it. It’s better to have a test that everyone can do. There have been studies showing that at-home screenings actually increase screening rates.