Another new way to avoid costly, dangerous colonoscopies

Last summer, I advised you that a new, non-invasive colon cancer test was coming. And now it’s here!

This alternative to colonoscopies became available last month. And it’s a boon to millions of people who prefer to avoid the discomfort, danger and expense of colonoscopies–and instead want to do their own colon cancer screening at home. The new test makes use of one of the long-awaited promises of biotech. It’s the first to detect cancer-related DNA in stool. You can’t get more precise than that.

This home procedure is a reliable test that doesn’t require the painful preparations that interfere with your life. Nor does it carry the dangerous risks and awful complications that may cost you your life. There’s no tortuous “prep,” no scope, no anesthesia–and no risk to the procedure.

But, of course, the threatened colonoscopy industry is already trying to dump on this new test. They admit this simple, safe test will boost effective screening for colon cancer. But then they try to claim that it will lure people away from colonoscopies, which they say have been “shown” to save lives.

This test will certainly “lure” people away from the costs and disastrous consequences of colonoscopies. And it will certainly make it easier, safer and more palatable for more people to get effective screening for colon cancer.

But hold on–the dodgy claim that colonoscopies are better at “saving lives” has never been proven. (A fact I’ve pointed out repeatedly here in the Daily Dispatch and in my monthly Insiders’ Cures newsletter.) While we do know that there can be real, fatal complications.

The fact is, we don’t have any head-to-head, controlled clinical trial comparisons of using colonoscopy vs. alternatives test like the old standby fecal occult blood test or FIT (fecal immunochemical test). And there are no comparisons for the new test.

Even the National Cancer Institute (NCI) experts say the new test looks promising. (And this organization, as you’ll recall, derided the new lung cancer screening test, largely based, as far as I can tell, on unethical and unscientific bias against lung cancer victims. Although the U.S. Centers for Medicare and Medicaid Services (CMS) finally just approved it for coverage under Medicare.)

The FDA approved the new colon cancer screening test in September. And the world-respected Mayo Clinic, where it was developed, now offers the test. Exact Sciences Corp of Madison, WI will sell it under the name Cologuard®. And the Mayo Clinic will get royalties. (So it does not exactly sound like another big pharma venture.)

The idea and procedure itself are simple.

Patients obtain and send a stool sample to the lab where the test detects any blood (like the old home tests). The presence of blood could indicate the presence of a tumor. Plus, Cologuard detects the presence of mutated DNA, which could signal cancer or a precancerous growth called a polyp.

If the test is positive for cancer, then the patient undertakes additional diagnostic steps, such as a colonoscopy or sigmoidoscopy, to remove the growth or polyp. Sigmoidoscopy, which looks at the lower portion of the colon (where cancers most commonly occur) is a safer option and doesn’t require sedation. In Europe, sigmoidoscopy is virtually the only “scoping” done.

Of course, the only real measure of the worth of any cancer screening procedure is whether it lowers the risk of cancer death. (As I have pointed out before, use of mainstream government-industrial-medical approaches to screening breast, prostate, and colon cancer have yet to specifically show to any clear benefits in actually reducing cancer death rates in the overall population.)

But this new Cologuard test does appear to lower the risk of cancer death…

In a large study, researchers compared Cologuard to one of the older tests for fecal blood. The Cologuard test detected 92 percent of colorectal cancers and 42 percent of precancerous growths (polyps). By comparison, the older fecal blood test only detected 74 percent of cancers and 24 percent of polyps.

Like any test, the increased sensitivity of Cologuard at detecting real cancers also leads to more false positives. In other words, the test can sometimes find evidence of a polyp or cancer where none is present. And it correctly rules out cancer 87 percent of the time (compared to 95 percent for the older blood test).

Critics complain this means 13 percent of patients may go on to get colonoscopies anyway who don’t really need them. But, let’s stop and think logically about this point for a moment. Do they really think it’s better to make 100 percent of patients get colonoscopies whether they need them or not…or just 13 percent of them who really do need them?

Cologuard can avoid the costs, risks, and problems of colonoscopy 87 percent of the time. And that’s a huge accomplishment.

Medicare jointly reviewed the Cologuard test with the FDA. (It was a rare example of sensible, federal bureaucratic coordination.) It will also pay for the test for Medicare patients, so the $599 cost should not be a barrier (especially when compared to the bloated costs of colonoscopies).

Now, keep these two things in mind…

First–it takes 15 years, on average, for a precancerous polyp to became a cancer. So there is time and opportunity to catch it with regular, non-invasive testing.

Second–you don’t need any fancy test to detect rectal growths. Government statisticians certainly like to lump all “colo-rectal” cancers together to make their “survival” rates look better. But colon cancer is very different from rectal cancer. And doctors can easily detect rectal growths, polyps and cancers with the old fashioned, digital rectal exam, as part of a routine physical examination. (If doctors are given enough time to do it anymore, that is.)

All statistics aside, sensible cancer experts say the best colon cancer screening test is one that people will actually go and get. So if the torturous colonoscopy prep turns you off, ask your doctor about this new Cologuard test. It’s yet another good alternative to dangerous colonoscopies.


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