Colonscopy Question

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Colonscopy Question

Postby tahoe60 » Tue Sep 20, 2016 9:51 am

Hello!
I had a colonscopy when I turned 50. They removed a small polyp and told me to come back in 10 years. I'm now 61 - put off having one. My doctor suggested the Cologuard test which I just did. It came back positive - she wants me to have a colonscopy now. I really don't want to, but must admit I'm concerned. I also just had foot surgery and noticed in my after surgery lists of do's and don'ts that invasive procedures such as colonoscopies are not recommended for 3 months. Do you have any knowledge of Cologuard test results - what a positive result might mean? Other options?
Thank you!
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Re: Colonscopy Question

Postby JeffN » Mon Oct 29, 2018 8:48 am

mountain wrote:If I remember correctly, Dr.McDougall prefers the Sigmoidoscopy over the Colonoscopy if there is a need for further check up. Is this still his recommendation?


Here are Dr McDougall's recommendations.

https://www.drmcdougall.com/misc/2014nl/aug/early.htm

I think it is also of benefit to see the recommendations by the major cancer organizations as, while we are led to believe that colonoscopy is the only recommendation, this is not true.

National Cancer Institute
https://www.cancer.org/cancer/colon-rec ... -used.html

USPSTF
https://www.uspreventiveservicestaskfor ... screening2

American Cancer Society
https://www.cancer.gov/types/colorectal ... ct-sheet#q

https://onlinelibrary.wiley.com/doi/ful ... caac.21457

Recommendations (From the ACS) (Just recently updated)

Options for CRC screening

Stool‐based tests
• Fecal immunochemical test every y
• High‐sensitivity, guaiac‐based fecal occult blood test every y
• Multitarget stool DNA test every 3 y

Structural examinations
• Colonoscopy every 10 y
• CT colonography every 5 y
• Flexible sigmoidoscopy every 5 y

As you can see, the stool-based tests are a valid and viable option.

If it was up to me, as I am at such a low risk, I would choose the FIT (Fecal immunochemical test) and maybe do it for a few years in a row and if they all came back negative, would probably stop or maybe check it once ever 5 years. It has one of the lowest false positive rates (of which the DNA has much higher false positive rates), and you do not need a doctor to order the test. You can order it online and do it at home yourself. If anything came back positive, I would retest.

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Re: Colonscopy Question

Postby Lyndzie » Mon Oct 29, 2018 11:20 am

This is great information. I have a family member who can’t have colonoscopies, and did not know what the alternatives would be.
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Re: Colonscopy Question

Postby JeffN » Tue Oct 30, 2018 7:38 am

Lyndzie wrote:This is great information. I have a family member who can’t have colonoscopies, and did not know what the alternatives would be.


As with many things, it seems that patient does not get fully informed. The non-invasive tests are also accepted methods of screening as the colonoscopy and the DNA test.

In regard to the non-invasive tests..

You can get the FIT test here
https://www.pblabs.com/collections/fit- ... est-2-pack

The FOB Is readily available
https://livewelltesting.com/instant-vie ... -test-kit/

The DNA needs a script
https://www.cologuardtest.com

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Re: Colonscopy Question

Postby JeffN » Fri Oct 11, 2019 10:40 am

Updated

Colorectal cancer screening with faecal immunochemical testing, sigmoidoscopy or colonoscopy: a clinical practice guideline
BMJ 2019; 367 doi: https://doi.org/10.1136/bmj.l5515 (Published 02 October 2019)
https://www.bmj.com/content/367/bmj.l5515

Recommendations
These recommendations apply to adults aged 50-79 years with no prior screening, no symptoms of colorectal cancer, and a life expectancy of at least 15 years. For individuals with an estimated 15-year colorectal cancer risk below 3%, we suggest no screening (weak recommendation). For individuals with an estimated 15-year risk above 3%, we suggest screening with one of the four screening options: FIT every year, FIT every two years, a single sigmoidoscopy, or a single colonoscopy (weak recommendation). With our guidance we publish the linked research, a graphic of the absolute harms and benefits, a clear description of how we reached our value judgments, and linked decision aids.


Colorectal cancer screening with faecal immunochemical testing, sigmoidoscopy or colonoscopy: a microsimulation modelling study
BMJ 2019; 367 doi:
https://doi.org/10.1136/bmj.l5383 (Published 02 October 2019)

Conclusions
Over a 15 year period, all screening strategies may reduce colorectal cancer mortality to a similar extent. Colonoscopy and sigmoidoscopy may also reduce colorectal cancer incidence, while FIT shows a smaller incidence reduction. Harms are rare and of similar magnitude for all screening strategies.


The QCancer® 15 yr, colorectal risk calculator:
http://qcancer.org/15yr/colorectal

Health Canada Risk Calculator
https://www.mycanceriq.ca/Cancers/Colorectal

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Re: Colonscopy Question

Postby frozenveg » Wed Oct 23, 2019 5:56 pm

Thank you, Jeff, for these great references. My husband recently took a Cologuard test as his doctor's request, and it came back positive. He wants to discuss alternatives with his doctor, before they rush him to a colonoscopy.

We are aware that the Cologuard test has a 13% chance of false positive results. I am not seeing the likelihood of false positive results for the other, less invasive tests. I'll plow back into all the links, but I'm hoping you may have those figures at hand. Can you help?
5'3", 74 YO. Started Jan. 11, 2010
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Current weight: 148.2.0


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Re: Colonscopy Question

Postby JeffN » Wed Oct 23, 2019 6:04 pm

frozenveg wrote:Can you help?


Scroll down to the 2 charts especially the second one

https://www.uspreventiveservicestaskfor ... screening2

Let me know if that helps

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PS, it’s high false positive rate is my main concern with the ColoGuard. If you get a positive result, now what?
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Re: Colonscopy Question

Postby frozenveg » Wed Oct 23, 2019 7:14 pm

Thank you very much. We agree—we succumbed to pressure to get the Cologard, and it was essentially useless. Luckily our insurance paid for it, but I hate the thought that wasted that money on the insurance company’s behalf.
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Re: Colonscopy Question

Postby JeffN » Tue Dec 17, 2019 2:53 pm

An interesting article on the ColoGuard

https://www.desmoinesregister.com/story ... 356936002/

“The U.S. Food and Drug Administration in September gave Exact Sciences Corp., Cologuard’s maker in Madison, Wisconsin, permission to expand the Cologuard patient population. Now, average-risk individuals ages 45 and older qualify, whereas before it was for those ages 50 or older. That expands the product's reach to an estimated 19 million more people.

The company also has increased its sales force promoting Cologuard to primary care physicians and hospitals under a new marketing partnership with Pfizer.

“In reading up on Cologuard, I learned that some gastroenterologists are concerned that people already are being prescribed the tests who shouldn't be.”

“The test also has a significant false-positive rate of 6% for those 50 to 65. Over 65, that rate goes up to 13%, according to Becker’s GI & Endoscopy.”
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Re: Colonscopy Question

Postby JeffN » Wed Jan 13, 2021 8:07 am

On the FIT test

A Colonoscopy Alternative Comes Home
An at-home test for colon cancer is as reliable as the traditional screening, health experts say, and more agreeable.

https://www.nytimes.com/2021/01/11/heal ... sting.html

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Re: Colonscopy Question

Postby REWohsnus » Fri Oct 22, 2021 4:36 pm

Jeff,

I can't get behind the paywall for the NYT Ariticle referenced just above.

Can you share the name and manufacturer of the test referenced:

A Colonoscopy Alternative Comes Home
An at-home test for colon cancer is as reliable as the traditional screening, health experts say, and more agreeable.

https://www.nytimes.com/2021/01/11/heal ... sting.html


Best,
ME
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Re: Colonscopy Question

Postby JeffN » Fri Oct 22, 2021 6:13 pm

It is the one mentioned above called the FIT test

BTW, they are like $20 each but you can get a 2 pack at the link for $29.

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PS earlier this year, the American College of Gastroenterology added the FIT test as a primary option for screening.

https://gi.org/patients/gi-health-and-d ... act-sheet/

Recommended Frequency for Different Screening Tests

We recommend the following tests as the primary screening option for patients at average risk for colorectal cancer on this schedule:
• Colonoscopy every ten years
• FIT every one year

If one of these alternatives is used, we suggest that the tests be done on this schedule:
• Multitarget stool DNA test every three years
• Flexible sigmoidoscopy every 5 to10 years
• CT colonography every five years
• Colon Capsule every five years
We suggest against Septin9 (blood-based test) for colorectal cancer screening.
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Re: Colonscopy Question

Postby REWohsnus » Sun Oct 24, 2021 4:10 pm

Thank you for the info Jeff! It is much appreciated.

Best
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Re: Colonscopy Question

Postby MINNIE » Mon Oct 25, 2021 12:13 pm

Thank you Jeff!

This is is timely. I just got a mailed reminder from my HMO to get the Cologuard test.
(I had it done three years ago, with a negative result).

I was reluctant to do it again, because of accuracy concerns. I didn't know about the FIT test, so thank you so much for that information.

FWIW I don't have a family history of colon cancer, haven't eaten meat in 40 years, and everything I now eat contains fiber :). So I doubt that I am at a high risk, but a simple home test is certainly worth doing. I had decided years ago that I would not do a colonoscopy - ever.
(Unless I got a suspicious result on a stool test).


Oddly, I live not far from Cologard headquarters in Wisconsin. The facility is already huge and seems to keep growing - looming rather ominously over the prairie ... so many colons yet to conquer I guess.
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