Perhaps you’ve reached the age (50) when your primary care doctor or gynecologist says, “It’s time for a colonoscopy.” This traditional medical procedure, which explores the colon for the presence of intestinal polyps, is not only invasive but costly and uncomfortable (even painful) as well. These factors make a colonoscopy a much less than desirable screening test, and so many adults disregard their doctor’s advice.
The good news? According to some experts, including Dr. James Allison, an emeritus professor at University of California, San Francisco, who worked in gastroenterology for four decades, “You should get screened, but there are excellent screening options available in addition to colonoscopy.”
What you should know about colonoscopy
Approximately 135,430 new cases of colon or rectal cancer will be diagnosed in 2017 in the United States, according to the National Cancer Institute, and more than 50,000 people will die of the disease. Colorectal cancer is typically a slow-growing cancer and can be treated effectively when it is caught early. For people who are at normal risk for the disease, a colonoscopy is usually repeated every ten years.
Doctors will typically tell you that a colonoscopy is safe. However, it can cause tears in the colon, inflammation or infection of sacs in the colon (diverticulitis), heavy bleeding, or severe abdominal pain. These complications can result in hospitalization, surgery, blood transfusions, or even death.
When preparing for a colonoscopy, you will need to follow a special diet and take laxatives the day before the procedure, or in some cases you will need an enema. Because the exam requires sedation, you will need to have someone drive you home and also take a day off from work. Depending on the type of health insurance you have, you may or may not be required to pay for some or all of the procedure.
Alternatives to colonoscopy
But what if there is an alternative? Actually, there are several other ways you can be screened for colon cancer. If you have no personal or family history of the disease nor any of the other risk factors for colorectal cancer (e.g., overweight or obesity, sedentary, diet high in red meat and processed meat, smoking, high alcohol use, personal history of inflammatory bowel disease or adenomatous polyps, presence of type 2 diabetes, being African-American or an Ashkenazi Jew), then you should talk to your healthcare provider about one or more of the alternatives to a colonoscopy. Even if you do have risk factors, one of the alternatives may be for you, so do schedule that talk!
Three tests for blood in poop
Currently there are three tests you can do at home that can identify blood in fecal (poop) samples. All require you to send your collected fecal sample(s) to a lab for analysis.
Fecal immunochemical test (FIT). This Food and Drug Administration approved screening test for colorectal cancer detects human blood from the lower intestines and is the first line colorectal cancer screening test used widely throughout the world, including Canada, Italy, China, France, Taiwan, and more.
To take this inexpensive (about $20) test, you collect a fecal sample after having a bowel movement, place it on the card provided with the test kit, and mail the sample to a lab. Your doctor may ask you to repeat the test because cancers of the colon do not always bleed. If the FIT results identify blood, your doctor may recommend a colonoscopy. When FIT is used every year, it can be just as effective as a colonoscopy.
Fecal occult blood test. Similar to the fecal immunochemical test, the FOBT also can be as effective as a colonoscopy if it is performed annually. Typically, the in-home test involves collecting fecal samples on three successive days and sending them to a lab for analysis. The stool guaiac test (guaiac is a plant substance used to coat the FOBT test cards) can detect hidden blood in stool samples. If blood is detected, your doctor will likely recommend a colonoscopy.
Stool DNA test. This relatively new colonoscopy alternative is much more costly than FIT (about $600), but it is recommended for use every three years instead of annually (as are FIT and fecal occult blood tests). It works by using advanced stool DNA technology to detect high levels of altered DNA and/or hemoglobin in abnormal cells shed by the colon. Currently, the only approved stool DNA test in the United States is called Cologuard.
Other reasons for blood in your poop
The presence of blood in your poop is not an automatic indication of colorectal cancer. In fact, there are many reasons blood may appear in your feces, and you should tell your doctor about any of them if you are aware you have any of these issues before you take these tests. Aside from growths or polyps of the colon, blood in your poop may indicate:
- Anal fissures (cracks in the lining of the anal opening)
- Intestinal infections that involve inflammation
- Crohn’s disease
- Ulcerative colitis
- Diverticular disease
In addition to a colonoscopy, three other invasive colorectal screening procedures include:
- A double-contrast barium enema, a type of x-ray which, if it detects an abnormality, will usually still require a colonoscopy
- A CT colonoscopy, which does not require sedation and, if an abnormality is found, will also need a colonoscopy for removal
- A sigmoidoscopy, which can see only a small portion of the intestines and is generally not considered an alternative to colonoscopy.
Natural ways to help prevent colorectal cancer
Disease prevention is always preferable to screenings and treatment in any form. A look at the risk factors for colorectal cancer provides clues as to natural ways to help prevent the disease, as they involve lifestyle choices. Therefore:
- Maintain a healthy weight
- Engage in regular cardio and strength exercises
- Don’t smoke
- Limit alcohol consumption to one (women) or two (men) drinks per day
- Limit or, preferably, eliminate proinflammatory foods from your diet, as they have been associated with an increased risk of colorectal cancer. They include red meat and processed meat, sugar, vegetable oil, refined flour, artificial sweeteners, and saturated fat.
- Focus on fresh, natural foods that are high in fiber, which help keep the intestinal system clear of toxins. These include fruits and vegetables, whole grains, seeds and nuts, and beans and legumes.
- In addition, consume foods that contain certain phytochemicals (e.g., anthocyanins/anthocyanidins, flavonoids, terpenes, and polyphenols) shown to fight cancer. They are found in plant foods such as citrus, berries, carrots, peppers, broccoli, soy beans, cabbage, and tomatoes, among others.
When alternatives to colonoscopies are performed as recommended, they can be just as effective as a colonoscopy in detecting cancer of the colon. However, if abnormalities are found, it may be necessary to undergo a colonoscopy to remove them.
American Cancer Society. Colorectal cancer risk factors
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Medline Plus. Fecal immunochemical test
Mills D, Gebhart F. Dreading a colonoscopy? Other tests are just as effective for colon cancer. Healthline 2015 Mar 20
Niclis C et al. Proinflammatory dietary intake is associated with increased risk of colorectal cancer: results of a case-control study in Argentina using a multilevel modeling approach. Nutrition and Cancer 2017 Nov 15: 108