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Is There a Way Around a Colonoscopy?

Q. A colonoscopy requires sedation, and you have to take a day off from work. Aren't there other screening tests that are effective, but less invasive?

Think about it this way: as inconvenient as it can be, it's a lot more inconvenient to have colon cancer. Colonoscopy remains the gold standard because not only can we detect cancer and the precursor, polyps, we can remove them at the same time.

Virtual colonoscopy is exciting because it's less invasive. But it still requires a prep, which is really the turnoff for most people. You still need to drink that half-gallon of solution to clean out the colon for virtual colonoscopy. And there are three other things about virtual colonoscopy that I think are not-so-great:

Number one is the radiation involved. If you think about this as a test you're getting done over and over again, that radiation can add up. Number two, virtual colonoscopy is not good at detecting small polyps. Small polyps turn into bigger polyps, which turn into cancer. So we're not so thrilled about a test that leaves these small polyps behind. Number three, if you have a virtual colonoscopy and you do have polyps, then you have to repeat the process to have the lesions removed during a regular colonoscopy.

Then, there's sigmoidoscopy. This is a test insurance companies love because it's cheap. But the problem is that it only examines the first third of the colon, and we know that polyps can occur throughout the colon.

There are also stool blood tests, which look for what's called fecal DNA. They look for traces of DNA in the stool from cancers. But we don't want to detect cancer. We want to find the polyp before it becomes cancer and remove it.

Another really exciting thing that's coming soon is the colon capsule. It's not FDA-approved yet, but it's a pill that has a little camera inside. There's one for the esophagus and one for the intestine already. The one for the colon takes pictures throughout the colon. That's very exciting. It should come before the FDA again next year.

A lot of these tests, I think, are still in their infancy. But the bottom line is that no matter how easy it is to do a colonoscopy -- in terms of the prep, it's not that bad. It's very safe. It's very easily done. It can remove lesions, and so on -- there's still going to be some people who say no way. So we need to have something to offer those people. If they're not going to do it, then we need to have some kind of screening for them.

Also for people who can't be sedated for medical reasons or something, stool blood tests and the others that are on the horizon can be very helpful. I think in the next decade or so we'll see a lot of therapeutic colonoscopy where people are having these other tests first. But for now, colonoscopy is still your best bet.

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