Alternatives to colonoscopy

Elsewhere on the site this week, we reviewed several news stories about claims for a new “laxative-free colonoscopy.”  Here’s more on alternatives to traditional colonoscopy in a guest post by Harold DeMonaco, MS – one of our expert editors on HealthNewsReview.org but also Director of the Innovation Support Center at the Massachusetts General Hospital.

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I just had the pleasure of undergoing my third screening colonoscopy.  At nearly 64 years of age, I should not have been scheduled until age 70.  But a small polyp was removed the last time, so the time interval recommendation was shortened.  As the gastroenterologist said, “It was one of the types we are interested in.”  This time around, three polyps were removed and I await the word from the pathologist to see if my friendly gastroenterologist will have a similar interest in one or more of the triplets.  I suspect I will be crossing the threshold into the GI unit in the next few years yet again.

For those who have never had the colonoscopy experience, I would point you to an article written by Dave Barry for the Miami Herald.  While a bit over the top, it is still worth reading perhaps after you have had the procedure.  It is not quite as bad as he makes it out to be but the space shuttle analogy is darned close.  And you will never have the same feelings about Abba and “Dancing Queen.”

Screening tests have pluses and minuses.  All have risks and presumed benefits.  Colon cancer is the second leading cause of cancer death in the United States.  It has been estimated that if every adult over the age of 50 years were screened about 19,000 lives would be spared annually.  Colon cancer can take years to develop so early detection has been shown to reduce the risk of advanced disease and death.  The U.S. Preventive Services Task Force published a set of recommendations in 2008 and recommended a staggered arrangement for screening beginning at 50 years of age and ending at age 75 years.  They also examined the relative value of each of the screening methods currently available.  Colonoscopy is the gold standard. Colonoscopy is also operator-dependent.  Not every physician can detect small polyps with equal ability.  Colonoscopy is not without risk.  About 4 out of every 10,000 people will have serious complication.  And, colonoscopies are expensive.  The HealthCare Blue Book lists a fair price of $1,360 for both physician and clinic fees.  This is a major barrier for low income people without healthcare insurance and perhaps one of the reasons that low income and minorities bear a disproportionate burden of colon cancer.

Other less expensive tests have a place given the access to care and cost associated with colonoscopy.  Here is what the Preventive Services Task Force said about them:

“The relative sensitivity and specificity of the different colorectal screening tests with adequate data to assess cancer detection—colonoscopy, flexible sigmoidoscopy, and fecal tests—can be depicted as follows:

Sensitivity: Hemoccult II < fecal immunochemical tests ? Hemoccult SENSA ? flexible sigmoidoscopy < colonoscopy

Specificity: Hemoccult SENSA < fecal immunochemical tests ? Hemoccult II < flexible sigmoidoscopy = colonoscopy”

So, if you are not necessarily interested in recreating a launch of the space shuttle, there are alternatives.

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Related note:

Dr. James Allison, a clinical professor of medicine emeritus at UC-San Francisco in the division of gastroenterology, comments frequently on alternatives to colonoscopy.   KCBS in San Francisco recently interviewed him.