Every year, March is noted as Colorectal Cancer Awareness Month. There is usually plenty of information in all areas of the media about using colonoscopy as a screening tool. This column highlights an alternative for those of you who are in the category of “not no how, not no way am I getting one of those.”
Keep in mind that a colonoscopy is still the gold standard of colorectal cancer (CRC) screenings because it can not only detect any cancer present but also prevent it by removing any polyps that are present. Polyps are growths in the colon that can become cancerous over time.
But…there are other testing methods for CRC that are acceptable alternatives for people at average risk for contracting it. Both the American Cancer Society and the U.S. Preventative Services Task Force state that high sensitivity FOBT (fecal occult blood test) or FIT (fecal immunochemical test) are effective screening options for colorectal cancer if they are done properly and yearly.
Let's look at what “average risk” means. That would cover people who have never had colorectal cancer, adenomatous polyps, Crohn's disease or ulcerative colitis. Other conditions for being in the average risk category are having no family history of CRC, polyps, or hereditary CRC. If any of those conditions are true for you, you are not a candidate for yearly FOBT or FIT. A colonoscopy on a schedule that you have discussed with your health care provider is your best bet.
What are these alternative tests looking for and how are they performed? The FOBT can detect minute (therefore hidden or occult) amounts of blood in the stool. Cancerous lesions often bleed a little bit, but not all the time. For that reason, the test needs to be done for three consecutive days. You must abstain from eating red meat and avoid certain medications for a few days before the test to avoid a false positive result. Your health care provider can give you a kit (fits in an envelope) to take home in order to do this test. You take a small sample of stool and apply it to a piece of specially treated paper in the kit. The kit is then returned to your health care provider or a lab where they use hydrogen peroxide to make that occult blood apparent.
The FIT test is similar to the FOBT in that it can detect hidden blood in the stool, but it is generally recognized as being more sensitive than the FOBT and it can detect bleeding from up higher in the colon. It is performed in virtually the same way as the FOBT, except the dietary and medication restrictions are lifted.
If blood is detected in the colon with either of these tests and no apparent source is uncovered, a colonoscopy is often the next diagnostic step.
Worried about the cost of these tests? If you have health insurance, one of the benefits of the Affordable Care Act (Obamacare) is that all preventive tests are free. No co-pay, just free. If you do not have insurance or insurance that doesn’t cover this testing, contact the Livingston and Wyoming Counties Cancer Preventive Services at wyomingco.net/health/cancerservices or 800-588-8670 for information about their free services.
What is the best test to screen for CRC? The one that you will do. If it's a choice between doing nothing and doing the FOBT or FIT, doing nothing is certainly not the screening method of choice!
Pam Maxson is a health educator at Noyes Hospital in Dansville. If you have questions or suggestions for future articles, she can be reached at firstname.lastname@example.org or 335-4327.