Dr. Gad Friedman
  • Welcome
    • About me
  • Endoscopy
    • Gastroscopy >
      • Tips for a better gastroscopy
      • Preparation form
      • Frequently asked questions
    • Colonoscopy >
      • Tips for a better colonoscopy
      • Preparation form
      • Frequently asked questions
      • After the colonoscopy
    • Sigmoidoscopy >
      • Preparation form
    • Video Capsule Endoscopy >
      • Preparation form
  • Digestion
  • Common symptoms
    • Bloating
    • Burping
    • Flatulence
    • Heartburn
    • Mucous in stool
    • Stomach Rumbling
  • Straight talk
    • Celiac disease
    • Colon cancer screening
    • Diverticulosis
    • Hemorrhoids
    • Inflammatory bowel disease >
      • What to talk about
      • How to choose your treatment
      • Is my treatment working?
    • Irritable bowel syndrome
  • Diets
  • How To

Colon cancer screening saves lives!

Colon cancer is important for everyone to consider.
Colon cancer affects about 5% of all people, men and women equally.
When to start screening and which screening test to choose depends on if you are at average or higher risk of colon cancer
Colon cancer affects 5% of our population



​What does average risk mean and when should I start screening?

Average risk means that you have no family history of colon cancer and no underlying chronic gastrointestinal illness that can increase your risk such is inflammatory bowel disease

An average risk person should begin colon cancer screening at age 50.

What are my options for colon cancer screening?

The main options include: indirect stool tests for blood (FOBT AND FIT) and direct tests such as endoscopy (sigmoidoscopy or colonoscopy) or a CT scan (CT colonography or virtual colonoscopy). New stool tests for cancer DNA are available as well.

Let's look at the pros and cons of each test

Stool tests

Test
Advantages
Disadvantages
Accuracy
Screening interval
Fecal Occult Blood Test (FOBT)
​No cleansing of the colon is necessary.



Samples can be collected at home.



The cost is low compared with other colorectal cancer screening tests.



No risks.
This test fails to detect most polyps and some cancers


May produce false-positive test results (the test suggests an abnormality when none is present)


Dietary restrictions and changes,  are often recommended for several days before a FOBT


Colonoscopy will be required if abnormal
Detection rate
varies from 9-64%
​Recommended

annually
Fecal Immunochemical Test (FIT)
​No risk.



No bowel preparation


No pre-test dietary restrictions


Sampling performed at home


Fairly inexpensive
May miss many polyps and some cancers


May produce false-positive test results (the test suggests an abnormality when none is present)


Should be performed annually according to guidelines


Colonoscopy will be required if abnormal
​Detection rate is
up to 65%
​Recommended

annually

Direct tests

​Test
​Advantages
​Disadvantages
​Accuracy
Screening interval
Colonoscopy
​This test allows the doctor to view the entire colon.



The doctor can perform a biopsy and remove polyps or other abnormal tissue during the test, if necessary.
Other diseases can be detected at the same time

Thorough cleansing of the colon is necessary before the test.

This is  an invasive procedure, so there is a risk of bleeding or tearing/perforation of the lining of the colon.
​Greater than 95% accurate in diagnosing colorectal cancer



Accuracy depends on the experience of the person doing the exam



This is considered by many experts to be the gold standard test
​Recommended every ten years
Virtual Colonoscopy
​This test allows the doctor to view the entire colon.


This is not an invasive procedure, so there is no risk of bleeding or tearing/perforation of the lining of the colon.
​This test may not detect all small polyps, non-polypoid lesions, and cancers, especially 5 mm or smaller.


Thorough cleansing of the colon is necessary before the test.
 
Radiation exposure
​

If a polyp or non-polypoid lesion 6 mm in size or larger is detected, standard colonoscopy will be needed to remove it

​Up to 94% detection rate for large polyps, 

Accuracy depends on the experience of the person reviewing the exam
​Recommended every 5 years

Stool test for cancer DNA

Test
Advantages
​Disadvantages
​Accuracy
​Screening interval
Stool DNA Test
No direct risk to the colon

No bowel preparation

No pre-test dietary restrictions
​
Sampling done at home

May miss many polyps and some cancers

May produce false-positive test results

More expensive than other stool tests

Still a fairly new test

Not clear how often it should be performed
​
Colonoscopy will be required if abnormal
​Detection rate is 72-77%
Undetermined
Picture
There is sometimes just too much information. Here is my simplified version.

A colonoscopy is still the best to find and remove polyps, but the quality of the exam depends on both you and the doctor. If doing an invasive test does not worry you then do a colonoscopy.

I reserve the virtual colonoscopy for patients who have difficult anatomy that makes it hard to do a colonoscopy or for a patient who is worried about the risk of a colonoscopy. Radiation exposure is a concern.

The only stool test I recommend is the FIT and I feel it should be done yearly. Increasingly, the FIT will become the first screening test offered because of its low cost.

​At this time, the stool DNA tests have not shown sufficient accuracy to be recommended

​

So what puts me at higher risk for colon cancer?

The main criteria is your family history. Other factors include a personal history of ulcerative or Crohn's colitis and certain genetic syndromes.

If you have a first degree relative with colon cancer than you are not at average risk only 

A first degree relative is: father, mother, brother, sister, son or daughter

Colorectal cancer or adenomatous polyps in any first-degree relative before age 60, or in 2 or more first-degree relatives at any age (if not a hereditary syndrome). 


Start at age 40, or 10 years before the youngest case in the immediate family, whichever is earlier

You should always do a colonoscopy since there is a higher chance of finding polyps. 
The colonoscopy should be repeated every 5 years

Colorectal cancer or adenomatous polyps in any first-degree relative aged 60 or older, or in at least 2 second-degree relatives at any age 



Start at age 40

You can do any of the option as those at average risk but most doctors would still recommend a colonoscopy


www.ourdigestivehealth.com
www.GadFriedman.com
  • Welcome
    • About me
  • Endoscopy
    • Gastroscopy >
      • Tips for a better gastroscopy
      • Preparation form
      • Frequently asked questions
    • Colonoscopy >
      • Tips for a better colonoscopy
      • Preparation form
      • Frequently asked questions
      • After the colonoscopy
    • Sigmoidoscopy >
      • Preparation form
    • Video Capsule Endoscopy >
      • Preparation form
  • Digestion
  • Common symptoms
    • Bloating
    • Burping
    • Flatulence
    • Heartburn
    • Mucous in stool
    • Stomach Rumbling
  • Straight talk
    • Celiac disease
    • Colon cancer screening
    • Diverticulosis
    • Hemorrhoids
    • Inflammatory bowel disease >
      • What to talk about
      • How to choose your treatment
      • Is my treatment working?
    • Irritable bowel syndrome
  • Diets
  • How To