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 45, far be it from us to stand in your way.

Time to talk about the dreaded colonoscopy.
The first good news is that, as you can tell from all the store window displays and promotions, March is colorectal cancer awareness month.
The other good news is that the colonoscopy guideline-writers, whom I suspect are all over 45 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, for older patients, carries a 1.7% chance of a complication. Your company's rate is likely to be much lower, but there is a chance an employee could end up back in the ER.
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 also requires contrast media, so it’s not a lot of fun.
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 CT scan, without being prompted?
2. Cologuard
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 UPS store was also shipping his “sample.” Needless to say we bonded immediately. (Not.)
The UPS agent said they shipped a lot of these samples nowadays. As far as I’m concerned, trust me again: 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 13% false positive rate. A “13% false positive rate” means exactly what you think it means: you’ll need a follow-up colonoscopy 13% of the time.
Not that your employees care since it’s all free to them, but the total cost of Cologuard, which is done every three years, may or may not approach the cost of a once-every-ten-years colonoscopy. There are so many moving parts in that calculation – the false-positive rate requiring a followup colonoscopy, the lost work time for a colonoscopy, the cost of treatment of complications in colonoscopies – that it’s hard to say with any certainty.
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 the least expensive of the three options. It is also the most effective in theory, as long as you remember to do it most years. However, in the immortal words attributed to the great philosopher Yogi Berra: "In theory, theory and practice are the same. In practice, they're different." And there is simply no way your employees are going to want to do this every year or even close to every year.
Plus, because it's sold over the counter, it's very difficult to track compliance. (You can't do that on an individual level anyway, but you can at least get a sense with the other options.) Further, unlike Cologuard, which sends a helpful personal reminder every three years (and unless you opt out, will send the actual test kit), no one is reminding anyone of FIT.
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.