General FDA approves blood test to screen for colon cancer

[Eric]

Good news for those of us who are afraid of a colonoscopy. Mine was a pretty bad experience and even though it came back clean I've been hesitant to get another one when they've requested it as a result. While this may not be "as good" at least it offers an alternative.

FDA approves blood test to screen for colon cancer

The new test could increase the number of people screened for colorectal cancer, especially among adults too young for routine colonoscopies.

www.nbcnews.com

 

[Herdfan]

Good news for those of us who are afraid of a colonoscopy. Mine was a pretty bad experience and even though it came back clean I've been hesitant to get another one when they've requested it as a result. While this may not be "as good" at least it offers an alternative.

FDA approves blood test to screen for colon cancer

The new test could increase the number of people screened for colorectal cancer, especially among adults too young for routine colonoscopies.

www.nbcnews.com

So I guess this is different that the Cologuard which runs commercials seemingly nonstop on my TV?

And does anyone ever have a good experience with a colonoscopy?

 

[Eric]

So I guess this is different that the Cologuard which runs commercials seemingly nonstop on my TV?

And does anyone ever have a good experience with a colonoscopy?

Right, which I've learned only screens for blood in the stool called a fecal occult test, if it sees it then they recommend a colonoscopy. Even then only 4% to 5% of those that tested positive actually have cancer once they're had the colonoscopy.

They have tests that look at DNA but Kaiser has never offered them. So this blood test seems like a good alternative IMO.

 

[Cmaier]

I told my doctor to F-off last month when she raised this issue. I told her that I’d worry about colon cancer right after they actually treat all the actual medical issues I’ve got (especially because nobody in my extended family has ever died of cancer). I get home and find she signed me up for that cologuard crap-in-a-box thing. Box is still sitting on my armoire.

This same doctor told me she thinks my blood pressure, which is finally under control, is now too low. Dingbat. I need a new doctor.

 

[fooferdoggie]

Going without food for a day would just wipe me out. Now that I had to fully dump all carbs I have to eat around 4000 calories a day just to be even.I am hungry a lot. Plus no nuts for 2 weeks would be so hard.

 

[Yoused]

no nuts for 2 weeks would be so hard

you would have to cut out two thirds of the news

 

[Roller]

Right, which I've learned only screens for blood in the stool called a fecal occult test, if it sees it then they recommend a colonoscopy. Even then only 4% to 5% of those that tested positive actually have cancer once they're had the colonoscopy.

They have tests that look at DNA but Kaiser has never offered them. So this blood test seems like a good alternative IMO.

Both Cologuard and Shield detect DNA markers for colon cancer, one in the stool (Cologuard) and the other in blood (Shield). Cologuard also looks for occult blood in the stool (occult because it's not visible without testing), which can be caused by colon cancer and many other conditions. There are other methods to detect fecal blood that have been around for many years, but they're not as sensitive.

I can't overemphasize how important it is to detect colon cancer early, when there's a > 90% chance of cure. The survival rate drops considerably if it isn't localized. Because it develops slowly, it's ideal for screening. Colonoscopy remains the best test because suspicious polyps can be removed before they grow too large. Colonoscopy is recommended every 10 years for people at average risk, beginning around age 45.

Colonoscopy itself should not be painful, since it's done with medications that essentially put you to sleep, but not to the extent of general anesthesia. I don't recall anything that took place during my last few procedures. The prep is unpleasant, but not as horrible as it's sometimes made out to be. The worst part is the liquid you have to drink, which tastes bad. Taking it cold and following it with apple juice makes a big difference.

I told my doctor to F-off last month when she raised this issue. I told her that I’d worry about colon cancer right after they actually treat all the actual medical issues I’ve got (especially because nobody in my extended family has ever died of cancer). I get home and find she signed me up for that cologuard crap-in-a-box thing. Box is still sitting on my armoire.

This same doctor told me she thinks my blood pressure, which is finally under control, is now too low. Dingbat. I need a new doctor.

With all due respect, ignoring your doctor's advice in this instance because nobody in your extended family has died of cancer is short-sighted. If you don't believe her or me, look it up yourself. There's plenty of information about colon cancer risks and screening on the web.

 

[Eric]

Both Cologuard and Shield detect DNA markers for colon cancer, one in the stool (Cologuard) and the other in blood (Shield). Cologuard also looks for occult blood in the stool (occult because it's not visible without testing), which can be caused by colon cancer and many other conditions. There are other methods to detect fecal blood that have been around for many years, but they're not as sensitive.

I can't overemphasize how important it is to detect colon cancer early, when there's a > 90% chance of cure. The survival rate drops considerably if it isn't localized. Because it develops slowly, it's ideal for screening. Colonoscopy remains the best test because suspicious polyps can be removed before they grow too large. Colonoscopy is recommended every 10 years for people at average risk, beginning around age 45.

Colonoscopy itself should not be painful, since it's done with medications that essentially put you to sleep, but not to the extent of general anesthesia. I don't recall anything that took place during my last few procedures. The prep is unpleasant, but not as horrible as it's sometimes made out to be. The worst part is the liquid you have to drink, which tastes bad. Taking it cold and following it with apple juice makes a big difference.

With all due respect, ignoring your doctor's advice in this instance because nobody in your extended family has died of cancer is short-sighted. If you don't believe her or me, look it up yourself. There's plenty of information about colon cancer risks and screening on the web.

The only test they ever give at Kaiser is "Occult blood, stool, immunoassay" where my doctor says it tests for blood, if it detects it then they recommend a colonoscopy. I've asked about one with DNA and they said they will only recommend the colonoscopy, so I guess it's not an option with them.

In my case I have diverticulitis and have had a colonoscopy in the past which showed clean but as a result sometimes there is tiny amounts of blood during an attack and my GI doctor said it's normal and recommended I no longer take the occult tests and just get another colonoscopy at 10 years after my last one.

 

[dada_dave]

The only test they ever give at Kaiser is "Occult blood, stool, immunoassay" where my doctor says it tests for blood, if it detects it then they recommend a colonoscopy. I've asked about one with DNA and they said they will only recommend the colonoscopy, so I guess it's not an option with them.

In my case I have diverticulitis and have had a colonoscopy in the past which showed clean but as a result sometimes there is tiny amounts of blood during an attack and my GI doctor said it's normal and recommended I no longer take the occult tests and just get another colonoscopy at 10 years after my last one.

yeah IBD here (UC), so unfortunately colonoscopies and sigmoidoscopies are a regular occurrence for me. do they not want more regular colonoscopies for your diverticulitis? to keep track of it? or is that not necessary/helpful?

 

[Eric]

yeah IBD here (UC), so unfortunately colonoscopies and sigmoidoscopies are a regular occurrence for me. do they not want more regular colonoscopies for your diverticulitis? to keep track of it? or is that not necessary/helpful?

They've recommended it but not realizing that I had one from a previous doctor, when I moved and switched to Kaiser getting my records was more trouble than it's worth. So I had to explain it.

Finally, I talked with a GI doctor and filled him in on all of it. His recommendation was to get the colonoscopy at 10 years after the last (which will be in 2026), as was the recommendation of the GI doctor who gave me the colonoscopy.

BTW my personal experience was terrible with it, I woke up puking and didn't take well to their meds, even though I told them I had a problem with nausea before hand. I had my gallbladder removed and it was a way more pleasant experience.

I'll ask my doctor about this new blood test at some point during my regular checkup this year.

 

[Edd]

I've had colonoscopies every 5-ish years since age 31, because my mother had colon cancer just before that. I was living in WA state, my parents flew in to visit, she felt sick, and was in the operating room < 10 hours after landing. A 4 day visit turned into 3 weeks. She did recover but unfortunately got liver cancer 2 years later and she went quick after that.

At 54, I've already outlived her, just had one done with good results. I'm lucky in that colonoscopies have never been an issue. The prep is worse than the procedure for me.

 

[Herdfan]

BTW my personal experience was terrible with it, I woke up puking and didn't take well to their meds, even though I told them I had a problem with nausea before hand. I had my gallbladder removed and it was a way more pleasant experience.

First time I went under anesthesia was my freshman year of college when I had some clean-up on my knee. They didn't give me quite enough so I woke up and immediately yacked what ever was left in my stomach (they said no food after mid-night, but being a college kid, that meant I could go to Burger King at 11pm ) all over the anesthetist. Of course, I was told AFTER the fact that I could ask for some anti-nausea medicine before being put under.

And I think I have been put under another 10 or so times since then and have always asked for the anti-nausea medicine and never had a problem. So you may want to ask for it.

 

[Roller]

They've recommended it but not realizing that I had one from a previous doctor, when I moved and switched to Kaiser getting my records was more trouble than it's worth. So I had to explain it.

Finally, I talked with a GI doctor and filled him in on all of it. His recommendation was to get the colonoscopy at 10 years after the last (which will be in 2026), as was the recommendation of the GI doctor who gave me the colonoscopy.

BTW my personal experience was terrible with it, I woke up puking and didn't take well to their meds, even though I told them I had a problem with nausea before hand. I had my gallbladder removed and it was a way more pleasant experience.

I'll ask my doctor about this new blood test at some point during my regular checkup this year.

Sorry you had a bad experience, but as you say, it doesn't have to be that way. The good thing (I suppose) for people not at increased risk is that you eventually reach an age where routine colonoscopy is no longer recommended because you're, well, old. Not to turn this political, but I wouldn't want to be the doc doing a colonoscopy on Trump. Judging from his courtroom experience, you'd at least want to be out of the line of fire.

BTW, I once had an upper endoscopy and colonoscopy in one session on the same day. Before they medicated me I made sure they were going to use two different scopes.

 

[Herdfan]

BTW, I once had an upper endoscopy and colonoscopy in one session on the same day. Before they medicated me I made sure they were going to use two different scopes.

My wife's GI doc was a client of mine so he knew my wife. She also had both done on the same day and he assured her he would wipe the scope off well between the procedures.

 

[Cmaier]

Both Cologuard and Shield detect DNA markers for colon cancer, one in the stool (Cologuard) and the other in blood (Shield). Cologuard also looks for occult blood in the stool (occult because it's not visible without testing), which can be caused by colon cancer and many other conditions. There are other methods to detect fecal blood that have been around for many years, but they're not as sensitive.

I can't overemphasize how important it is to detect colon cancer early, when there's a > 90% chance of cure. The survival rate drops considerably if it isn't localized. Because it develops slowly, it's ideal for screening. Colonoscopy remains the best test because suspicious polyps can be removed before they grow too large. Colonoscopy is recommended every 10 years for people at average risk, beginning around age 45.

Colonoscopy itself should not be painful, since it's done with medications that essentially put you to sleep, but not to the extent of general anesthesia. I don't recall anything that took place during my last few procedures. The prep is unpleasant, but not as horrible as it's sometimes made out to be. The worst part is the liquid you have to drink, which tastes bad. Taking it cold and following it with apple juice makes a big difference.

With all due respect, ignoring your doctor's advice in this instance because nobody in your extended family has died of cancer is short-sighted. If you don't believe her or me, look it up yourself. There's plenty of information about colon cancer risks and screening on the web.

I did look it up. I have a very small chance of dying from colon cancer. I am much more likely to die in lots of other gruesome ways.

 

[cbum]

Roller's comments are right on.
Historically, the occult blood test was the only screening available, and it was low yield, because tumors bleed irregularly, and there are many other reasons for bleeding.
As the genetics of ColonCa was researched, molecular tests became feasible, which can be done on blood or stool samples. They are much more useful, since they can detect the cancer-associated mutations. One issue there, in addition to sensitivity (the smaller the tumor, the less DNA is released, the easier it is for a false negative), is that these mutations occur at varying times during tumor evolution (benign hyperplasia, atypical hyperplasia, in-situ cancer, invasive cancer, metastatic cancer), so you may detect precursor lesions, which is actually a feature, not a bug.
Totally agree with importance of catching ColonCa early - the chemo options once the horse has left the barn (metastasis) are poor and mostly just prolong the dying.
@Cmeier: your lack of family history is not very relevant for ColonCa - only ~30% are familial, 70% sporadic (meaning you acquired the mutations yourself). Sorry to hear you have other things to worry about, but screening is one of the most powerful inventions of modern medicine - use it when you can.
And sorry to hear those of you with bad experiences with endoscopies, it does not have to be that way, as described above.
I have had several, combined lower & upper endoscopies, since I also have GERD which comes with increased risk of Barret's oesophagus, which is a precancerous lesion. My GI guy puts me on an IV, tells me to count to 10, and I wake up at 4 or 5 with everything done.
No sweat.

 

[Eric]

I did look it up. I have a very small chance of dying from colon cancer. I am much more likely to die in lots of other gruesome ways.

Agreed, and even though I am in a higher risk bracket with my condition I still don't want another one. I think this probably common and that's why they say even though the blood test may not be as good, it's still better than nothing at all.

 

[Cmaier]

Agreed, and even though I am in a higher risk bracket with my condition I still don't want another one. I think this probably common and that's why they say even though the blood test may not be as good, it's still better than nothing at all.

it just drives me crazy when i go see my doctor because my car was rear-ended and i have neck pain, and she ignores what i am saying, tells me to take aspirin, and changes the subject to my ass. Then I go see a neurologist for other reasons and he says I have C6/C7 damage. Or this last time: “My blood pressure is great, and I’d just like to renew my prescriptions.” Her: “come back in a month for yet another complete physical, oh, and your blood pressure is almost too low sometimes, so let’s just go drop the meds and see how you like 180/130. Also, when are you going to get that tube shoved up your ass?”

It’s like GP’s have a script, and they don’t care what your actual concerns are.

 

[Roller]

Roller's comments are right on.
Historically, the occult blood test was the only screening available, and it was low yield, because tumors bleed irregularly, and there are many other reasons for bleeding.
As the genetics of ColonCa was researched, molecular tests became feasible, which can be done on blood or stool samples. They are much more useful, since they can detect the cancer-associated mutations. One issue there, in addition to sensitivity (the smaller the tumor, the less DNA is released, the easier it is for a false negative), is that these mutations occur at varying times during tumor evolution (benign hyperplasia, atypical hyperplasia, in-situ cancer, invasive cancer, metastatic cancer), so you may detect precursor lesions, which is actually a feature, not a bug.
Totally agree with importance of catching ColonCa early - the chemo options once the horse has left the barn (metastasis) are poor and mostly just prolong the dying.
@Cmeier: your lack of family history is not very relevant for ColonCa - only ~30% are familial, 70% sporadic (meaning you acquired the mutations yourself). Sorry to hear you have other things to worry about, but screening is one of the most powerful inventions of modern medicine - use it when you can.
And sorry to hear those of you with bad experiences with endoscopies, it does not have to be that way, as described above.
I have had several, combined lower & upper endoscopies, since I also have GERD which comes with increased risk of Barret's oesophagus, which is a precancerous lesion. My GI guy puts me on an IV, tells me to count to 10, and I wake up at 4 or 5 with everything done.
No sweat.

Thanks for posting. As I'm sure you know, screening recommendations, even for conditions like breast, lung, and colon cancer, are open to debate. And guidance at the population level may be more or less relevant for individuals depending on age, co-morbidities, and so on, but it's a start. In general, the US Preventive Services Task Force does a good job summarizing and explaining what they say about screening for various diseases. (I was involved in providing expert opinion for a different cancer.)

I'm of the opinion that non-invasive tests for malignancy based on genomics, proteomics, and such will continue to improve and enable us to limit the more expensive and invasive investigations to the people who really need them, but we're not quite there yet.

BTW, I used to have a cartoon that showed a patient lying prone on an exam table with an endoscope entering his mouth. The other end was poking out his rear end.

 

[Roller]

it just drives me crazy when i go see my doctor because my car was rear-ended and i have neck pain, and she ignores what i am saying, tells me to take aspirin, and changes the subject to my ass. Then I go see a neurologist for other reasons and he says I have C6/C7 damage. Or this last time: “My blood pressure is great, and I’d just like to renew my prescriptions.” Her: “come back in a month for yet another complete physical, oh, and your blood pressure is almost too low sometimes, so let’s just go drop the meds and see how you like 180/130. Also, when are you going to get that tube shoved up your ass?”

It’s like GP’s have a script, and they don’t care what your actual concerns are.

If your doctors aren't listening to you — one of the most important attributes of being a physician — you need to find ones who do. I've always had docs who took the time to hear what I had to say, and I switched if they didn't.