Hi Readers,
Dr. Tabibian here. It’s been a difficult week for our country.
I sincerely hope you are doing well on this Sunday evening (Dr. Storage says hi, too).
With that said, we’re going to stick to what we do best: giving you valuable gut health tips that you can’t always find on Google or with ChatGPT.
One of you asked us a great question last week:
When it comes to colon cancer screening, do we recommend a less-invasive test first (like FIT or Cologaurd), or to go straight to colonscopy?
I’ll break it down below.
WHY YOU SHOULD READ THIS NOW
Colorectal cancer is the second leading cause of cancer death in the U.S. But it doesn‘t have to be - it’s almost entirely preventable.
Screening should start at age 45 for average-risk adults (earlier if you have family history or other certain risk factors).
I see a lot of patients who think the choice is “colonoscopy vs nothing.” That’s a misconception. There are other options, but not all are created equal.
Today’s Opponent:
Confusion About Colon Cancer Screening
There are 4 options for colon cancer screening:
FIT (Fecal Immunochemical Test)
Uses antibodies to detect globin, a protein in hemoglobin. Globin gives blood its red color. If blood is detected in stool, it could indicate presence of a colon polyp or cancer. It can also be a false positive from microscopic bleeding from hemorrhoids, which are very common.
Needs to be repeated every year because it isn’t very sensitive.
A positive result always means you need a colonoscopy. Though false positives are fairly common.
Truth be told, I seldom use FIT in my practice. It’s widely used in some health systems, but I find it too limited.
Cologuard (Stool DNA Test)
Combines FIT with an analysis of genetic markers linked to polyps and colorectal cancer.
More sensitive than FIT and only needs to be repeated every 3 years.
As with FIT, a positive result means colonoscopy. False positives can occur.
If someone is average-risk and declines colonoscopy, Cologuard is my preferred alternative.
CT colonography (or virtual colonoscopy)
A CT scan of the colon performed after bowel prep
Provides 2D and 3D images of the colon, but can only detect polyps greater than or equal to 6mm. If a polyp is detected, you need a colonoscopy.
If normal, it is done every 5 years.
It's not entirely noninvasive as it requires a rectal insufflator to fill the colon with air in order to be able to visualize polyps.
Colonoscopy
Still the gold standard. It’s the only test that actually examines the entire colon and allows me to remove polyps on the spot.
Typically done every 10 years if normal, more frequently if abnormalities found or certain risk factors are present.
It’s true, it’s more involved: bowel prep, sedation, a day off work. But it is the ONLY test that prevents cancer, not just detects it. (And it allows for up to a 10 year repeat interval).
👉 My bottom line:
Colonoscopy is the most powerful tool we have.
If you can’t or won’t opt for a colonoscopy, Cologuard is the next best choice.
FIT is acceptable but far from ideal.
With rare exceptions, get screened! And get it done at 45, not 50. If you’re high-risk, you may need to start at 40 (or younger), and colonoscopy is the way to go.
What To Tell Your Doctor
“I know I need screening, but I’m not sure which test is best for me. Should I go straight to colonoscopy, or is Cologuard reasonable in my case?”
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As gastroenterologists, we definitely have a lot to talk about when it comes to your gut health and well-being. But we can’t always get to everything (you know… like coffee enemas)! So reply directly to this email or DM us on TikTok below and maybe YOUR topic will be featured soon!
