Colonoscopies the Gold Standard: Other Screening Tools 

February 26, 2019

Colorectal cancer is a leading cause of mortality in the US, and last year the American Cancer Society began recommending screening at age 45 for those at average risk. The age had previously been 50.

But many health insurers only pay for colonoscopies, considered the gold standard of colorectal cancer screening, for people beginning at age 50, said Dr. Drake Lavender, assistant professor of family medicine for the College of Community Health Sciences.

But there are other screening tools, Lavender said during a presentation as part of the Mini Medical School program, a collaboration of the College and The University of Alabama OLLI program. Among them:

The fecal-occult blood test is the most common worldwide and detects blood in the entire gastrointestinal track. The test is inexpensive and can be done at home. The fecal immunochemical test detects blood in the lower GI track and is more effective than the fecal-occult blood test, but, like that test, doesn’t have the best sensitivity for detecting pre-cancerous polyps, Lavender said. Same for the Cologuard test, which combines the fecal immunochemical test with DNA bio markers, he said.

The CT colonography provides good sensitivity for detecting pre-cancerous polyps, but if such polyps are found a colonoscopy is recommended to remove the polyps, Lavender said. He said a flexible sigmoidoscopy can be performed in a doctor’s office, doesn’t require sedation and is more convenient than a colonoscopy. But it only looks at one-third of the colon, and if polyps are found a colonoscopy would be recommended to remove them.

A colonoscopy is the most widely used colorectal screening tool in the US. The test allows visualization of the entire colon and allows physicians to detect – and remove – polyps. Colonoscopies are recommended every 10 years for people at average risk of colorectal cancer and if their colonoscopies are normal.

When should colorectal screening stop? Lavender said between the ages of 76 and 85, taking into account a patient’s overall health considerations and risks versus benefits.

There are things people can do to reduce the risk of colorectal cancer, Lavender said, including a diet low in red and processed meats, not smoking and reducing consumption of alcohol.

The Mini Medical School program has been put on by faculty and resident physicians of the College since 2016. It provides an opportunity for adults and community learners to explore trends in medicine and health, and the lectures offer important information about issues and advances in medicine and research.