Making the BEST choice

Published 8:15 pm Friday, March 16, 2018


Good. Better. Best.

Whether we are choosing an automobile, clothing or simply a fast-food burger, we have choices to make. Do we make our decisions based on cost, efficiency, ease of use or maybe the highest quality?

In health care these same choices often arise. Is one test better than another? Does medical cost drive your healthcare choices? What about quality? Do you seek out the “best” care or just something that is “good?”

March is colon cancer awareness month. It’s an opportunity to step back and look at the choices you have for evaluating your colon health and protecting your life. Should you pick something that’s good, better or best?

Let’s look at one of the new options for colon cancer screening. Perhaps you’ve seen the advertising already. It features a “happy face” box with the tag line is “Get, Go, Gone.” Here’s how it works. Order a kit (Get), collect a stool specimen (Go) and send it out for testing (Gone). A report is then sent to your doctor advising you whether you have colon cancer or not. It’s that simple … No colon prep, no time off work, no invasive procedures. Pretty “good,” right? Basically, it’s a simple stool test that can tell you if you have colon cancer or significant pre-cancerous polyps. What could be better?

However, let’s look a little closer. First of all, the test is only indicated for patients considered to be low risk for developing colon cancer. It is not advised for people with a history of polyps, a family history of colon cancer or those with other high risk characteristics.

Second, and most importantly, the data for this test doesn’t hold up. This test “misses” 8 percent of the cancers, 30 percent of the large, pre-cancerous high risk polyps and 60 percent of all advanced and large, flat polyps. Further, it is falsely positive 13 percent of the time, meaning the test is reported positive when really there is nothing there. So, one might ask, what information are we really getting from this test? Is the purpose of screening to tell someone they have colon cancer, or should the screening tell us when we have pre-cancerous polyps that need to be removed? Obviously, the intent of screening is to prevent cancer, and this test clearly doesn’t meet that goal.

Although this stool kit is a FDA approved test, is this really our “best?” How often does it need to be performed? Are we confident our colon is OK if the test is negative? (no) Should we be satisfied with a test that misses a large number of cancers and an even larger number of soon-to-be cancerous polyps? (definitely not) Should we accept missing 8 of 100 cancers? (not at all).

Proponents of this test want us to accept “good” when we otherwise could have the “best.” This is a potentially life and death choice. We need to choose wisely.

My professional advice: don’t short change yourself for a little convenience.

To be complete, there are some other screening tests also in use but none are satisfactory as standalone screening modalities that reliably detect colon polyps and cancer. Colonoscopy remains the standard to which all other tests should be compared. Performed by skilled physicians, a colonoscopy is safe, effective and finds essentially 99 percent of all large polyps and cancers and the smaller polyps too. It is also the only colon screening test that is both diagnostic (finds the polyps) and therapeutic (allows the polyps to be removed). Sure, it’s a little inconvenient, but having a colonoscopy remains the Gold Standard (“best”) for colon cancer screening and prevention. Upon completion of a properly performed colonoscopy, you should be satisfied and assured your colon exam was complete. So, which one will you ask for: good, better or best?

One final note on colon-cancer screening. Don’t ignore symptoms such as bleeding, abdominal pain, unexplained weight loss or change in bowel habits. These could be signs of a developing cancer and need to be evaluated even if under age 50. Data has shown that about 10 percent of colon cancers arise in people who have not reached the traditional screening age of 50.

Remember, you only get one chance at life. Fear the cancer, not the screening!

Thomas Ruffolo, MD, is a gastroenterologist with Vidant Gastroenterology–Washington.