Dr. Zorba Paster: Choose the colon cancer test that works for you

Dear Doc: I'm approaching 45 and don't want to have a colonoscopy. The idea of having a tube shoved up my rectum and drinking all of that stuff makes me hyper anxious.

I know I should do it. I have a wife and two kids. But isn't there an easier way for me to screen? No one in my family died from colon cancer. I eat pretty good, lots of fruits and veggies, exercise, am a little bit overweight but not much, and don't smoke. What is my real risk anyway? — E.L., from Minneapolis

Dear E.L.: You're doing everything right to try to keep from getting colon cancer, but you're still at a normal risk. More than 50,000 people will die from colon cancer, which as we know if caught early or in the precancerous stage, can be cured before it fires up and gets out of control.

Beyond the colonoscopy, there are other options for screening. But before getting into that, let me caution you of one thing: No test is 100% accurate. A recent showed that an AI-assisted colonoscopy detected more polyps and cancers. In the future, colonoscopies should be even more accurate.

I had a friend a few years ago who died from colon cancer that was missed on a colonoscopy he'd had one year earlier. The cancer was up at the beginning of the colon, an area called the caecum, which is filled with tufts and folds.

He had a good gastroenterologist at a good institution, but they failed to detect anything wrong. He had symptoms 11 months later and died a year or so after that. So no test is perfect.

Let's start with the cheapest, the yearly FIT, or fecal immunochemical test, which looks for fecal blood that might be caused by a polyp or cancer. If this test is positive, then it's off to a colonoscopy for you. If it's negative, then you just repeat it the next year.

At a cost of $90, the FIT is dirt cheap. Kaiser Permanente, the huge California group, recommends this to most folks who are willing to do this annually. A recent study, again, in the Annals of Internal Medicine showed how useful FIT testing is. You don't need a bowel prep, you don't need to take a day off work, and for many it's a more acceptable way to screen.

Then you have our homegrown Cologuard test from Exact Sciences, the company headquartered in Madison. It's a DNA test you do every three years, incredibly accurate if you have cancer. The cost is about $750.

Neither the FIT nor the Cologuard test are as accurate at detecting polyps as the colonoscopy, the "gold standard" for colon screening. This test comes in at $3,500.

Interestingly, the colonoscopy is often covered without any out-of-pocket expense — that is, no deductible — when given as a screening test; under Obamacare, it is to be available without cost. But if you have a positive FIT or Cologuard test, or blood in your stool, a subsequent colonoscopy is "for cause" and, therefore, your deductible will apply. That means it costs you.

It's just one more example of the incredible stupidity that resides in our health care system's costs.

Now, let me throw a rather interesting wrench into this whole process. In a recent 10-year European study, folks who got screening colonoscopies had a rate of 0.84% colon cancer. Those who were not screened had a rate of 1.22%. So screening did detect the cancers.

But this was the paradox of the study: There was no difference in the death rate between the two groups. So the screening picked up the presence of cancer for sure, but the death rate wasn't changed. Did colon cancer surgery have a risk that added to this death rate? We're still trying to figure out exactly what this means.

My spin: Yes, get screened for colon cancer, but pick what works best for you. Stay well.

This column provides general health information. Always consult your personal health care provider about concerns. No ongoing relationship of any sort is implied or offered by Dr. Paster to people submitting questions. Any opinions expressed by Dr. Paster in his columns are personal and are not meant to represent or reflect the views of SSM Health.

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