Ask the Doctor: Is there an alternative to a colonoscopy?

The U.S. Preventative Services Task Force has updated its screening guidelines in the last year to recommend starting screening for colorectal cancer at age 45.

A colonoscopy is a minimally-invasive procedure, often done under light sedation. During a colonoscopy, the colon and bowel are explored for polyps. Polyps can form on the lining of the colon, and while they are often harmless, they can turn into cancer if not removed. This type of test is usually done every 10 years, but if you are at an increased risk for colon cancer or abnormalities are found in the initial colonoscopy, more frequent testing may be needed.

In a Cologuard test, a stool sample is sent through the mail and is analyzed for abnormalities. This test is generally done every one to three years if no abnormalities are found. Please note that a colonoscopy remains the most sensitive test for detecting colorectal cancer and identifying precancerous polyps. Stool-based tests like Cologuard, are a reasonable alternative for individuals who are unable or unwilling to undergo a colonoscopy. If abnormalities are detected in the Cologuard test, a colonoscopy may be necessary.

One important note is that certain risk factors or pre-existing conditions may make a difference in when to start screening and which screening is right for you.

Additionally, socioeconomic factors and race can increase colorectal cancer risk. Based on research, it’s known that colorectal cancer disproportionately affects individuals from low socioeconomic backgrounds. Studies have shown that these individuals have up to a 31 percent higher risk of developing colorectal cancer. We also find that African Americans, both men and women, have the highest incidence and mortality rate with colorectal cancer.

New studies have shown genetic variability. The location of some of these polyps or cancerous cells can be a little bit different in African Americans, which can actually make it more difficult to detect them.

Inflammatory diets, poor gut health, and autoimmune diseases can increase the likelihood of developing certain kinds of cancers. Some studies have found more inflammatory bacteria from colonoscopy samples of African Americans versus non-Hispanic white individuals.

Based on these risk factors, some medical societies recommend starting screening earlier than age 45 for African American individuals, which is why it is important to talk with your primary care provider about when to start screening.

(The information provided in this column is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always talk with your doctor regarding a medical condition or treatment.)