Colon Cancer Screening: Any Test Better Than No Test at All
Colon cancer is the second-leading cause of cancer death in the U.S., with about 160,000 new cases diagnosed each year and 56,000 deaths attributable to the disease. The goal of screening is to detect and remove polyps before they turn into cancer, so regular testing is critical for those at high risk.
Fecal occult blood testing is one of several tests routinely used to screen for colon cancer, and there is much controversy regarding which test or combination of tests is best for people who have no symptoms.
The American Cancer Society and most other advocacy groups recommend fecal occult blood testing for everyone over the age of 50, but roughly 70% of people in this age group in the U.S. have never had any kind of colon cancer screening.
Flexible sigmoidoscopy, in which a flexible tube with a light and camera on the end probes the lower third of the colon, is also recommended every five years. Colonoscopy is widely recognized as the most accurate test available, but it is also the most expensive and requires sedation.
Despite mounting evidence that screening for colon cancer saves lives, many doctors are still reluctant to recommend the procedures to their patients, says Steven H. Woolf, MD a professor of family practice at Virginia Commonwealth University.
"While we debate among ourselves about which test is best, most people aren't being tested at all," Woolf tells WebMD. "My philosophy with my own patients is that if I can get them to get screened with any one of these tests, I am happy. I think there is a move toward shared decision-making in general, because patients are more empowered than they were even a few years ago. They come in with more information." Woolf wrote an editorial that accompanies the study.
Researcher Ernest Hawk, MD, of the National Cancer Institute, agrees. The biggest factor in reducing deaths from colon cancer is not which test a patient has, he says, but getting patients to be tested at all. Hawk is chief of the Gastrointestinal and Other Cancers Research Group for the Institute's Division of Cancer Prevention.
"Each of these tests has limitations and benefits. Because this decision is so complex, it probably should be left to those being tested," he tells WebMD. "There is no question that doing something with regard to testing is better than doing nothing. Everyone who is older than 50 should undergo some form of colorectal cancer screening."
Edward Leigh believes that routine testing should begin at age 40 with a colonoscopy to start with, and he points out that 10% of colon cancers in the U.S. are diagnosed in those under the age of 50. He adds those with symptoms should be checked for the disease immediately -- no matter what their age.