Future of colorectal cancer screening

People don’t exactly look forward to their next colonoscopy. They might be eager for its conclusion or for the comfort of knowing they’re cancer free, but most regard the colonoscopy as the GI equivalent of a root canal. You know you need it, but it isn’t going to be pleasant.

Recent developments in the field of colorectal cancer screening, however, suggest that the dread factor maybe a thing of the past. Many doctors are already recommending futuristic-sounding screening procedures, such as the virtual colonoscopy. And a few years down the road, standard screening might even be as simple as swallowing an endoscopic capsule or dropping off a stool sample at the lab. They are 100 percent sure that the way we do colorectal cancer screening with colonoscopy now won’t be the way we will do several years from now. Though stresses that colonoscopies are by far the best method of screening currently available, confident that other, less invasive procedures will soon be ready to step into the spotlight.

One such procedure that many doctors and researchers have heralded as the future of colorectal cancer screening is the virtual colonoscopy. Comparable to x-rays, the images produced by virtual colonoscopy allow doctors to examine your colon from afar. Although this promising new procedure spares the patient much physical discomfort, it still requires the preparatory cleaning of the colon – a time-consuming process that many people find just as objectionable as the actual colonoscopy.

The endoscopic capsule, which records video images of its 24-hour journey through the GI tract, is also receiving a great deal of attention from doctors and researchers. Currently, the capsule is used primarily to explore hard-to-examine portions of the small intestine, but developers predict it will eventually become a major force in colorectal cancer detection.

Another new screening technique that is sure to generate an enthusiastic public response involves screening stool for genetic mutations. A study on this new approach, which was conducted at the Mayo Clinic and published in the November 2001 issue of Gastroenterology, reported some very exciting results. The Mayo researchers analyzed stools from 61 subjects (21 of whom were cancer patients) and tested DNA from each specimen for three specific types of gene mutation, each believed to be a reliable indicator of colorectal cancer. Ultimately, 19 of the 21 cancer cases were successfully identified by the presence of the selected genetic markers. Based on these results alone, stool DNA testing has a sensitivity rate of 91 percent, slightly lower than a colonoscopy, but significantly greater that the fecal occult blood tests that doctors recommend annually. And, as an added bonus, this procedure, unlike the virtual colonoscopy, requires no unpleasant colon prep.

Before getting carried away and canceling that colonoscopy you finally got up the nerve to schedule, you should know that, although these findings are very encouraging, this new stool screening approach is nowhere near ready for its public debut. One doctor predicts that they have to wait two or three years before this procedure becomes available for general use. Researchers are still debating which genetic targets are most reliable, and all agree that further exploration and experimentation is needed to confirm the results of the Mayo study.

Also keep in mind that, while non-invasive procedures such as this one appear more user-friendly initially, they quickly lose their appeal once an abnormality is detected yet cannot be investigated further until a colonoscopy is performed. Only a colonoscopy permits doctors to take issue of samples and remove polyps immediately. Colonoscopies are one-stop shopping. If you find something wrong, you take care of it right away. You don’t have to worry.

Whether colonoscopies will still be the most thorough approach to colorectal cancer screening a few decades down the road, no one can know for sure. In the meantime, doctors’ orders remain the same. All adults over the age of 50 should be screened regularly for colorectal cancer. Though there procedures currently available to you other those colonoscopies, such as fecal occult blood testing, flexible sigmoidoscopy or a barium enema, doctors often recommend that these options be combined. Talk to your doctor to find out which of these screening procedures are right for you. Waiting for a less invasive procedure, such as stool DNA testing, to become the standard of care might mean waiting until it’s too late.