Get a Colonoscopy or Use an At-Home Screening Test?

When it comes to our health, we might discuss our latest diet or exercise routine with friends and co-workers. We may even talk with them about our child’s ear infection, a recent bout with the flu, and of course, the latest COVID-19 news. Yet some topics — especially a subject like colon cancer screening — are typically off-limits for discussion with anyone outside of our family.    

While colon cancer may not be the most popular topic up for discussion, many people have questions about the best method for screening and how different screening options work. The LeBauer Gastroenterology team has put together this guide to some of the most common questions patients ask.    

Screening Age 

Age 45 is now the magic year to start colon cancer screening for patients at average risk according to the American Cancer Society and US Preventative Task Force.  Until 2020, the age to begin screening was 50. Research has shown an increasing number of people having colorectal cancer and precancerous polyps found in those before the age 50, and this has led to the new guideline changes.    

If you have a family history of colorectal cancer or if you have inflammatory bowel disease, you are already at higher risk, and you should start screening earlier.    

At-Home Screening: “What about those tests I’ve seen advertised on TV?” 

There are several different types of at-home screening methods that analyze material in your stool. If any of these tests come back positive, a colonoscopy is needed as a follow-up procedure.  

• Fecal Occult Blood Tests (FOBT) can also be performed at home and must be repeated yearly. 
• Fecal Immunochemical Tests (FIT)  look for hidden blood in your stool. You simply secure your sample and send it to the lab for testing. This test is more accurate and presents fewer false positives than fecal occult blood tests. It must be repeated yearly. 
• FIT-DNA Tests (Cologuard) also look for blood in the stool sample and check for DNA cells for evidence of cancer or precancerous abnormalities. This test is only for average-risk patients and needs to be repeated every three years.  

While these three tests are better than no screening at all, there are several reasons that a colonoscopy remains the best option. 

• During a colonoscopy, doctors can not only detect signs of cancer and biopsy/sample but they can also remove polyps.  Polyps can be pre-cancerous or benign.  If a polyp is pre-cancerous and removed completely, we are essentially able to prevent them from growing and potentially becoming cancer.  
• Patients do not have to worry about a false-positive result with a colonoscopy. 
• If no polyps are found during a colonoscopy, it only needs to be repeated every ten years.  
• The cost of a screening colonoscopy is typically covered by insurance. Stool-based screenings may also be covered by insurance. However, if a stool-based test is positive, the follow-up colonoscopy will probably be considered diagnostic and fall under the patient’s insurance deductible.

Understanding Colonoscopy:  “Is the preparation as bad as the stories I’ve heard?” 

A colonoscopy is most effective when your colon is entirely cleaned, allowing the doctor to better see the walls of the colon. You may have heard a family member describe preparing for a colonoscopy. In recent years, many doctors have switched to a split-dose preparation that requires drinking less liquid at one time/sitting.   You will drink part of the preparation the night before and part of it the morning of the procedure.  While spending several hours in the bathroom may not feel great, remind yourself that you are possibly preventing colon cancer if you have a polyp that needs to be removed. As well, identifying colorectal cancer as early as possible can make more treatment options available for you if needed.    

Make Time to Talk to Your Doctor 

If you are approaching age 45, have a family history of colon cancer/colon polyps or have symptoms that are concerning you,  please take time to talk to your primary care doctor about colon cancer screening. You can also schedule a colonoscopy directly by calling LeBauer GI at (336) 547-1745 or request an appointment with a gastroenterologist using our online form.  

Our gastroenterology team sees patients at two locations: our office on Elam Avenue in Greensboro and at MedCenter High Point.