Do I Need a Colonoscopy?

Colonoscopy… a dreaded word. The prep and liquid diet the day before, the idea of a doctor putting a camera in an uncomfortable place, the day off work and being put under anesthesia. Not the ingredients for a good time.

Is there an easier way? Do you really NEED a colonoscopy?

According to the U.S Preventative Services Task Force (USPST) once you hit the age of 45 you should start getting colon cancer screenings.

A colonoscopy is still the “gold standard” or most highly recommended screening for colon cancer.

So what is it? A colonoscopy is a procedure where a gastroenterologist, a gut doctor, puts a camera inside your colon to look for any polyps or growths that could be cancerous.

This is an outpatient procedure most often done in a surgical center or gastroenterology suite. During the procedure you are asleep, but the most uncomfortable part is the day before your colonoscopy.

About 24-36hrs before your colonoscopy you are put on a clear liquid diet the day before as well as given a “prep” to completely clear your gut of stool. This is necessary so your doctor can see any polyps or cancerous spots during your colonoscopy. There are several different types of prep, but the most common ones used now are either a small amount of liquid (about 1.5oz) or several pills. You usually take two separate doses combined with a large amount of water in between them. You will most likely spend a large amount of time on the toilet as your bowels empty out. While slightly unpleasant, this process is vital to make sure your doctor doesn’t miss anything during your colonoscopy.

The upside to a colonoscopy is that your doctor can both find any cancerous spots and if it is small actually treat the cancer by completely removing the polyp.

How often do you need a colonoscopy? Well, if it is normal, you have a colonoscopy every ten years. However, if there are any polyps or concerning spots your doctor may recommend you have one sooner.

But what about the “poop in the box test” you might be asking. There are different types, but the most used one is a multi-target stool DNA test. The brand name you may recognize is Cologuard. This test uses a stool sample and tests it for blood and cancerous DNA.

This can be easier than a colonoscopy since it is done at home with no prep needed. If your test is negative, it is recommended you repeat the screening in 3 years. However, if positive, you will need a colonoscopy to further evaluate for colon cancer.

The downside to the multi-target stool DNA test is the need for screening more frequently as well as having a small possibility the test could miss colon cancer.

So which method should you choose?

I always recommend colonoscopies to my patients since it can both diagnose the cancer as well as treat the cancer if it is early. However, for patients that refuse to get a colonoscopy a multi-target stool DNA test is a good second choice.

Any colon cancer screening is better than no colon cancer screening at all.

If you are over the age of 45 talk to your primary care doctor about screening for colon cancer.