This blog post is about colon screening, not colon testing. If you have an actual reason to need a colonoscopy other than you haven't had one for 10 years or just turned 50, far be it from us to stand in your way.
Time to talk about the dreaded colonoscopy. As you can no doubt tell from all the store window displays and promotions, March is colorectal cancer awareness month. That's only the start of the good news.
The other good news is that the colonoscopy guideline-writers, whom I suspect are all over 50 by now, don’t want a colonoscopy any more than you do. Hence, they now say a colonoscopy once every ten years is OK, up from every five.
The procedure itself is uncomfortable and carries a 1.7% chance of a complication. That means a company with 150 people getting screened will see two landing back in the doctor’s office, the ER or even the hospital. (The odds are actually a bit more favorable than 1.7%, because complications are more common in older patients.)
And that fluid they make you drink for 24 hours beforehand? I don’t know what’s in it but, in the immortal words of the great philosopher Dave Barry, it should never be allowed to fall into the hands of America’s enemies.
The better news is there are three non-invasive alternatives that can avoid both the discomfort and the complications of a routine colonoscopy screening. Let’s look at each in turn.
1. Virtual Colon Scans
We can nix this one posthaste. It’s amazing that this is still presented as an alternative, especially by the Mayo Clinic, which should know better. First, you still have to drink the fluid. Second, it requires contrast media, so it’s not a lot of fun. (Use your imagination to figure out why…)
Third, abdominal scans “reveal” so many unsought findings elsewhere in your abdomen that these findings even have a name: incidentalomas. The vast majority are harmless, but being told you have a “growth” can be quite stressful and may lead to more invasive testing.
Most importantly, these scans are full of radiation. About a decade ago, there was a dustup at the FDA, which had been considering a disclosure of the radiation for virtual colon scans but ultimately declined to require one. A whistleblower was fired over this issue. We don’t want to get involved in the politics of it all, but when was the last time any doctor informed you of the radiation risk of any scan, without being prompted?
The second has a very long name, the commercial version of which is called Cologuard. It arrives at your house in a big box, with some user-friendly instructions inside. I just did this one myself. It was easy enough. To be blunt, you poop into a container, pour in some preserving fluid, and then immediately put the lid on it. (The directions don’t actually specify “immediately,” but trust me when I tell you that “immediately” can’t come soon enough.)
Then you re-box the container and peel off your own incoming address label to reveal the return address label below.
Next, you call UPS or just take it in, like I did. Curiously, the other customer in the store was also shipping his “sample,” so needless to say we bonded immediately. (Not.)
The UPS agent said they shipped a lot of them nowadays. As far as I’m concerned, UPS can’t pay these guys enough.
Like the colonoscopy, Cologuard misses some true cancers. (The faster-growing cancers can show up between screens. Screens are more likely to catch the slower-growing, less lethal, ones.)
It also carries a 20% false positive rate. A “20% false positive rate” means exactly what you think it means: you’ll need a follow-up colonoscopy a fifth of the time.
Not that your employees care since it’s all free to them, but the total cost of Cologuard, which has to be done every three years, probably exceeds the cost of a once-every-ten-years colonoscopy. (So many moving parts, including the false-positive rate vs. the cost of treatment of complications of the colonoscopy, that it’s hard to say. It’s close.)
3. Fecal Immunochemical Testing
That brings us to the Fecal Immunochemical Test, or FIT. This is quite easy as well, but needs to be repeated every year, and has a risk of false positives too. You need to get a bit more up-close-and-personal to collect your “sample” than you do with Cologuard, so you must wash your hands afterwards.
You shouldn’t need us to tell you to wash your hands after going to the bathroom, but some of you don’t. And we know who you are. That’s because we’re a trivia company. We know everything.
The FIT is by far the least expensive of the three options. But it is also the most effective, as long as you remember to do it most years. As a baseline, if 100,000 people over 50 are screened at all, 4,857 cases of colon or rectal cancer would not be diagnosed until a patient presented with symptoms. That would lead to 1,782 premature deaths over those lifetimes. By contrast:
Annual testing with FIT should reduce cases of colorectal cancer not found via screening to 1,393 and deaths to 457. This realistic model assumes you “forget” your FIT one year out of every three.
Colonoscopy done every ten years, with follow-up exams every 3 to 5 years when polyps were found, would reduce cases to 1,825 and deaths to 624. (Plus about 1700 complications, 1 of which would be fatal.)
As an employer or health plan, the additional advantage of educating employees/members on non-invasive alternatives is encouraging more of them to be screened. And, yes, that’s where Quizzify comes in. We have a customizable quiz designed to accompany your annual health fair or screening initiative, for screenings recommended by guidelines. You can learn more about it by hitting the button below.