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Colonoscopy isn't the only good colon-cancer screening option for women

No doubt about it: Colon cancer screening saves lives.

So colonoscopy sleepover parties, like the one that’s going to be held for women later this month in Minneapolis, are a great idea — for fully insured women who have the time and money to participate in them, that is.

But many women are either uninsured or have health insurance with high deductibles. For them, a colonoscopy will put them back hundreds or even thousands of dollars.

This is a particular problem for African-American women. Although they are much more likely to be diagnosed with colon cancer than white women, they are also much less likely to have job-based health insurance.

And many women, of course, are hesitant to have a colonoscopy because of the required advance prep — the laxatives that have to be taken the night before to clean out the colon.

Other options
Fortunately, although colonoscopy is the preferred method of screening for colon cancer in the United States, it’s not the only good screening option for women, according to a report issued this month by the American College of Obstetricians and Gynecology (ACOG).

The report urged doctors to encourage all women to be screened regularly for colon cancer beginning at age 50. But it also stressed that doctors should discuss all screening options with their patients so that women will choose the one that they’re a) most comfortable with and b) most likely to actually do.

Those screening methods include, in addition to colonoscopy, flexible sigmoidoscopy and fecal occult blood testing (FOBT). (These are the same three methods recommended by a U.S. Preventative Services Task Force in 2008.)

Here’s a brief summary of the advantages and disadvantages of all three methods:

  • As this new ACOG report points out, colonoscopy provides a view of the entire colon, including the right side, where 65 percent of advanced cancers tend to be found. It can also be used to find and remove polyps, growths that may develop into tumors. The procedure is conducted under sedation and only needs to be repeated every 10 years (if the results are negative and the patient is not otherwise at high risk for colon cancer). Serious complications — most notably perforation of the colon and bleeding — are rare, but do occur in about 3 of 1,000 women.
  • Flexible sigmoidoscopy views only the lower part of the colon and may miss some right-sided lesions. The prep is a bit easier, though, and sedation is not required. It also has a lower risk of complications, although you’ll have to undergo the test every five years.
  • As its name suggests, fecal occult blood testing detects hidden blood in stool, which can be an indication of colon cancer. This test has its own unpleasantries — you must smear a stool sample on special cards and then mail or take them to a lab or to your doctor’s office — and it doesn’t identify potentially precancerous polyps. But, as the ACOG report notes, studies have shown that this comparably easy and inexpensive test — if done annually — is effective at identifying colon cancer at an early and curable stage. (This is the screening test used by the National Health Service in Great Britain, where it's conducted every other year.)

Of course, if either the sigmoidoscopy or FOBT come back positive, a follow-up colonoscopy will be recommended.

Other types of screening tests, such as virtual colonoscopy (which involves computed tomography, or CT, scans) and fecal DNA testing are mentioned in the ACOG report, but are not recommended for widespread use. Their long-term benefits and risks have not yet been established. (There are radiation risks associated with virtual colonoscopies, for example.)

Know your risk
It’s important to note that these options are for women who are at average risk of developing colon cancer. Women at high-risk — those, for example, who have a personal or family history of colon cancer or colon polyps or who have certain illnesses, such as Crohn’s disease — should be screened with colonoscopies and perhaps starting even earlier than age 50, according to the ACOG report.

So talk with your doctor about your risk factors for colon cancer. And ask about all your options. The important thing is to get screened. This is a cancer where early diagnosis and intervention truly does save lives.

You’ll find detailed information about colon cancer screening at the National Cancer Institute’s website.

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