Colon screening took a great leap forward with the FDA approval today of the COLOGARD stool test. This test does genetic screening on your bowel movements to check for genetic defects that are found in cancerous polyps and tissues that are sloughed-off into the bowel movement. Using this $599 test, you will be able potentially to avoid colonoscopy by screening for hidden blood & genetic material in the bowel, to look for the earliest signs of polyp growth or cancer formation.
Barriers to the broad use of this type of testing include: lack of equivalence to colonoscopy (which is still superior to this type of screening for finding cancers and polyps, cost (it’s not cheap…and insurance is not going to pay for this), and the need for patients to handle their own feces to get the sample.
Here is the process for collecting the stool specimen (CLICK>>>>HERE<<<<) Is this too much to ask of our patients…to handle their own poo? I don’t know…but Ben Stiller put it best when he asked on the YOUTUBE BELOW (just click it)
Colon cancer has a large preventable component through early screening and detection, and despite the general safety and tolerability of colonoscopy, many people hesitate due to the preparation required, or due to the perceived risk of the test (which is small..but real.)
Other ways we screen for cancers and polyps is through testing for microscopic blood in the bowel movement, either at the time of a rectal exam (for men…during their prostate exam, or for woman, when they have their gynecologic exam). Alternatively, these bowel screenings are done with home kits that allow the collection to be made in private. These are useful screening tools, but they are not quite adequate or equivalent colonoscopy.
Enter Colo-Guard, a new bowel kit that looks for genetic material sloughed off in the bowel movement, genetic material that is found in precancerous polyps and cancerous tissues. The latest study in the New England Journal of Medicine finds that this test, combined with the microscopic blood test, improves the value of such testing and has an accuracy that will allow for general use in the future. This is good news in the ongoing attempt to pre-empt a potentially dangerous cancer.
Two large studies have shown that screening for colon cancer is an effective tool in reducing your risk for dying from colon cancer. Both articles appeared in the respected New England Journal of Medicine.
One study looked at colonoscopy, and found a 70% reduction in your chances of dying from colon cancer. A second study showed simply checking for microscopic blood in the bowel movement (like is done at a routine annual exam) reduces the risk by 30+%.
And don’t delude yourself into thinking that ‘you’d know’ if you need to be screened. It is 100% clear that the majority of people to early stage colon cancer and significant polyps have ZERO symptoms….so that excuse is BULL!
A large Danish study demonstrates a reduced cancer risk in people on statin medications like Lipitor. This good news should be interpreted with some caution as study does have some limitations, but the fact that the medication did not show an increase risk of cancer issues is great news for those millions of us on medication.
Statin medications are the ‘cell phones’ of the modern pharmacopia…..we just can’t live without them and they are a boon to our lives. If you are in need of cholesterol-lowering, using medications are effective and increasingly proven to be safe.
Aspirin is just over 100 years old. Developed by Bayer Chemical, the same year as they developed Heroin, they would both go on to have famous careers. Actually, Bayer thought Heroin would be much more popular….little did they know.
Aspirin remains a great medication for a whole host of issues, but among the most important is it’s ability to prevent colon cancer. This has been demonstrated in multiple studies and is among the reasons daily aspirin remains legitimate, despite the controversy about it’s ability to prevent vascular issues.
Now, studies are identifying the benefits of aspirin for colon prevention is related to specific genetic modifications in the colon polyps and tumors. These studies show that if a person with colon cancer has their tumor analyzed, and they find a specific mutation called PIK3CA, then aspirin provides an 80% reduction in cancer recurrence. Great news for these people, but patients with other mutations do not get much, if any, benefit from aspirin use
This past week the FDA approved a lower-volume colonoscopy preparation called PREPOPIK (funny name.)
The Baltimore Sun on-line reports:
Prepopik is a combination of sodium picosulfate, magnesium oxide and anhydrous citric acid with an orange flavoring. It is taken in two doses: either both doses the day before the colonoscopy or one dose the day before and one the morning of the exam.
In two large clinical trials, the drug was compared to conventional preparation. The two doses given the day before were as effective at cleansing the bowel as the conventional procedure, while the doses given the night before and the morning of the procedure were more effective. Cleaning the bowel thoroughly is important because it removes materials that can interfere with identifying polyps.
A lower volume prep will be better tolerated and greatly appreciate by those of us who have had to endure the routine preparation for colonoscopy.
This new preparation appears safe and has been used in other countries for a number of years and has 2.8 million patient experiences with the product. This is encouraging as previous low-volume preps have run into trouble, including Fleet’s Phopho Soda which was taken off the market due to kidney injury.
A just-released study in the NEJM (New England Journal Of Medicine) has clearly shown the benefits of colonoscopy.
In patients with polyps (called adenomatous polyps…a specific type of polyp under the microscopic), removal of these polyps reduces the future risk of colon cancer by 50%…..a statistically large margin.
It is important to have proof that screening tests work as doctors and patients alike to wonder…..”What is all the fuss & does this screening test really work?”
Clearly, there are benefits to this testing, so it’s time to make sure you get your colonoscopy after age 50.
Sure….you can wait a little bit if you are squeamish, but don’t put it off forever. Let’s do what we can to prevent when possible.
This week’s Lancet Journal (from England) has an important study supporting the use of aspirin in preventing colon cancer.
Aspirin at 600mg daily (equivalent of 2 full dose pills) yielded a significant reduction in colon cancers in patients with Lynch Syndrome (a genetic predisposition to colon cancer). Although not clearly applicable to other patients with polyps or sporadic cases of colon cancer, it is good evidence to support the possibility that such patients would benefit.
Combining the heart and stroke prevention abilities of aspirin with the colon cancer data provides more support for use of aspirin as a general preventive in adults.