James Swenson

No one likes to think about colorectal cancer, a disease that can attack the colon, rectum or both. But think about this: colorectal cancer is the second-leading cause of cancer-related deaths in the United States. It’s also one of the most preventable cancers.

The best way to do that is with a colonoscopy.

While the procedure itself is painless, the biggest hassle is the “prep,” which often involves using a liquid diet and laxatives beforehand. Still, colonoscopies are considered the gold standard for colorectal cancer screening.

These tests can detect cancer in its earliest stages, and doctors can remove pre-cancerous polyps during the exam, preventing the disease from forming.

However, it is not the only screening available. In recent years, at-home tests have made colorectal cancer screening more convenient, begging the question: Are they an effective alternative to a colonscopy?

Here are some pros and cons:

The biggest advantage to using an at-home test (Cologuard is a frequently advertised example) is that you don’t need to do any kind of prep. In addition, at-home tests are noninvasive, you’re not sedated and you don’t need to take a day off work.

However, it’s important to note that some noninvasive colonoscopy alternatives are better than others in detecting cancers. For instance, fecal immunochemical test (FIT) only detects blood in the stool and misses 20% of colorectal cancers, whereas a product like Cologuard tests for blood, DNA mutations and other biomarkers – and is more sensitive.

A major downside is there are more false-negative results with at-home tests than with colonoscopies, suggesting that cancer is absent, when it really isn’t. As a result, at-home tests are less likely than colonoscopies to find cancer.

And people who opt for at-home screenings might not be able to avoid colonoscopies entirely. If an at-home test is positive, you will need to have a colonoscopy.

Finally, you’ll need to retake the test every three years, but if you’re at average risk, you need a colonoscopy only once every 10 years.

With colorectal cancer, early detection leads to better outcomes. So if you have any of the following risk factors, your doctor will most likely recommend a colonoscopy rather than an at-home test:

• personal history of previous polyps;

• personal history of colorectal cancer, inflammatory bowel disease, or radiation to the abdomen;

• strong family history of colorectal cancer or syndromes linked to colorectal cancer, such as Lynch syndrome.

The American Cancer Society (ACS) recommends that adults at average risk for colorectal cancer begin at age 45 and continue once every 10 years until age 75. Multiple “first degree” relatives with colon cancer or one with colon cancer under the age of 50 suggests a possible hereditary colon cancer syndrome and might require earlier screening.

March is colorectal cancer awareness month. Regardless of what you and your doctor decide is best for you, celebrate by getting screened.

Dr. James Swenson is a board-certified gastroenterologist with Beaufort Memorial Lowcountry Medical Group. He sees patients in both Bluffton and Bluffton.