How to Screen for Colorectal Cancer: gFOBT vs FIT vs Colonoscopy
Colorectal cancer (CRC) is the third most common cancer in the United States and the second most common cancer in women after breast cancer worldwide. The current recommendation for colorectal cancer screening is to start at age 45, but cases are appearing in younger adults at a higher rate than we’ve seen historically. Although colonoscopy remains the gold standard for screening, there are alternative screening techniques that come with their own pros and cons.
Guaiac-based fecal occult blood test (gFOBT)
This test can also be done at home, or in the clinic. It involves providing a small stool sample that is spread on a gFOBT test card which is then sent to a laboratory to be tested for the presence of hemoglobin which could be present as a result of bleeding from a colon lesion.
Pros:
Minimally invasive
More convenient than a colonoscopy
More accurate than FIT
Cons:
Requires dietary and medication restrictions
Three consecutively passed stools from different days are needed
Screening annually
A colonoscopy may still be necessary
Reduced accuracy (compared to colonoscopy)
DNA fecal immunochemical test (FIT)
If you're looking for a CRC screening method that's convenient and can be done at home, you might consider using a Cologuard testing kit. They'll mail it directly to your doorstep. All you need to do is collect a small sample of your stool at home and send it back to their lab for analysis. This kit checks for DNA from colon polyps, which in some cases may be associated with cancer. If the test detects any such DNA, a follow-up colonoscopy is necessary. Many people find this method much easier and less invasive than a colonoscopy.
Pros:
Convenient
Minimally invasive
No dietary or medication restrictions required
One stool specimen is needed
Screening every 3 years
Cons:
A colonoscopy may still be necessary
Least accurate
Colonoscopy
A colonoscopy is a test where a doctor inserts a scope with a camera into your colon to look for any suspicious polyps or lesions. You will be mildly sedated for this procedure. If they find anything concerning, they might remove it or keep an eye on it for future exams. If a polyp is removed, they'll send it to the lab to see if it's cancerous or not. If it is, your doctor will talk to you about next steps, which might include chemotherapy or radiation treatments.
The downside to this method is the prep. The night before your colonoscopy, you'll need to take a few pills or drink a (not-so-great-tasting) solution that causes you to "cleanse" your colon. It's understandable to feel a bit anxious about this - nobody likes the idea of having diarrhea! But most people find that getting through the prep is the hardest part of the colonoscopy experience.
That being said, colonoscopy is the gold standard for a reason. It's better at finding polyps, and they can be removed during the exam if needed. If you get a normal result from your initial colonoscopy, you might not need another one for 5-10 years. In comparison, Cologuard requires screening every 3 years, and gFOBT needs to be done every year. So while the prep might be tough, it's worth it to get the most accurate and comprehensive screening possible.
Pros:
Most accurate
Only needed every 5-10 years after a normal result
You will be sedated for the entire procedure
Polyps can be removed during the procedure for testing
Cons:
Prep is the worst part
You’ll need to recover from sedation
In conclusion, there are multiple screening options available for colorectal cancer, including FIT, gFOBT, and colonoscopy. Each method has its own pros and cons, and the best choice for you may depend on factors such as personal preference, family history, and overall health. It's important to talk with your healthcare provider about which method is right for you, and to stay up to date on your recommended screening schedule. While screening may not be the most enjoyable experience, it can potentially save your life by detecting colorectal cancer early, when it's most treatable.
Schedule an appointment with us to talk about which option is right for you.
