More good ways to avoid colonoscopy, and more reasons you should

In August, the FDA approved a new, non-invasive colon cancer screening test called Cologuard. This safe, effective test has some real, practical advantages over dangerous and costly colonoscopies.

First off, it’s a simple stool test similar to the fecal immunochemical test (FIT), which detects blood in the stool. But the Cologuard test also detects DNA mutations, which may indicate cancer cells shed from the colon into the stool.

In a large, clinical trial involving 10,023 men and women, researchers compared the safety and effectiveness of Cologuard to FIT. The Cologuard test detected 92 percent of colon cancers and 42 percent of advanced premalignant growths. By comparison, FIT found 74 percent of the cancers and 24 percent of the premalignant growths.

In terms of avoiding false positives, Cologuard was correct 87 percent of the time. Granted, FIT was correct 95 percent of the time. But to help reduce the odds of a false positive, doctors always can order these two safe, noninvasive tests together.

Currently, Medicare and the FDA are jointly reviewing and determining the screening frequency for Cologuard. It should lead to early approval for this test to be done once every three years for Medicare patients aged 50 to 85 years. And since the average time for development of a premalignant growth to turn into cancer is about 15 years, this will be welcome news for those at average risk of colon cancer.

Of course, despite this new advancement in effective, safe, non-invasive screening for colorectal cancer, the mainstream continues to portray colonoscopy as a benign, safe procedure–and the No. 1 choice for everyone.

But in my forensic medicine practice, I saw case after case of perforated intestines and peritonitis (a potentially fatal inflammation of the abdominal lining), lacerated and punctured livers with massive bleeding, and other fatal complications. All from “routine” colonoscopies.

Plus, colonoscopy is–by far–the most expensive screening test that Americans are exhorted to undergo.

I gave subscribers all the details of this dangerous, grisly procedure last year in the September 2013 issue of my Insiders’ Cures newsletter. (Newsletter subscribers can look up this issue for free in my online archives at www.drmicozzi.com. If you’re not yet a subscriber, now is the perfect time to get started.)

Thankfully, more and more evidence suggests an end may be in sight for this dangerous and costly cancer-screening procedure…

In fact, a brand-new study published in the Journal of the American Medical Association (JAMA) shows flexible sigmoidoscopy is yet another viable alternative to colonoscopy. In fact, only about 20 percent of those who received a sigmoidoscopy had to be referred for a colonoscopy. So it saved 80 percent of the participants from undergoing a needless, dangerous, and expensive test.

Furthermore, among the 2,520 colonoscopies performed, there were 15 perforations of the colon. By comparison, there were no perforations among the 13,000 sigmoidoscopies performed.

In other words, using the simple sigmoidoscopy test would avoid four-fifths of colonoscopies and 100 percent of colonic perforations. Clearly, sigmoidoscopy is far easier, less invasive, and less expensive than colonoscopies.

Evidence continues to pour in supporting these safe and effective colon cancer screening alternatives.  In many other advanced nations, sigmoidoscopy and the FIT test are the dominant modes of screening. Yet colonoscopy is still the most commonly recommended and performed colon cancer screening procedure for Americans. In fact, in the U.S., doctors rarely order a sigmoidoscopy. And they primarily order it for underinsured and uninsured populations. (Ironically, this less expensive, alternative may actually work out better for the under- and uninsured in the long run.)

As I always say, this is the bottom line when it comes to any type of cancer screening…

Does it reduce mortality rates? In other words, does it save lives?

When it comes to colon cancer, colonoscopy does not save more lives than these other alternative screening tests. In fact, reduction in mortality and gain in longevity appear similar for a combination of sigmoidoscopy (done every five years) with fecal occult blood testing (done periodically) compared to colonoscopy (done every 10 years). What more evidence do we need now?

Between the new Cologuard test–and the proven standbys of sigmoidoscopy and fecal occult blood testing–the vast majority of Americans do not need to get a colonoscopy. And, for routine screening, few should ever receive a colonoscopy as a first resort, before undergoing these other tests.

Sources:

  1. “Effect of Flexible Sigmoidoscopy Screening on Colorectal Cancer Incidence and Mortality: A Randomized Clinical Trial,” JAMA 2014;312(6):606-615
  1. “FDA Approves Cologuard for Colorectal Cancer Screening,” Medscape (www.medscape.com) 8/12/2014

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