Ask the Expert: Sean Fine, MD
Colorectal cancer is the second leading cause of cancer-related death in the US, according to the CDC. Regular screening—recommended for anyone aged 45 to 75 who’s at average risk—significantly reduces the chance of developing and dying from the disease. Yet many people are deterred by the inconvenience, fear, and general unpleasantness of preparing for and getting a colonoscopy. Fortunately, other tests are available that are equally effective at detecting and preventing colon cancer. Gastroenterologist Sean Fine RES’14 F’17, MD, MS, the director of the Inflammatory Bowel Disease Center and assistant professor of medicine at Brown, says the best test is the one a patient is most comfortable performing.
Colonoscopy gets the most hype because it’s a one-step process that is both diagnostic and therapeutic: if we find a polyp we can remove it there and then. I recommend it to my friends and family for this reason. The preparation has come a long way, and after the procedure almost all my patients say it was much easier than they had expected. But I do appreciate patients’ concerns. Health care is expensive, people have to take time off, people in rural areas may have to travel to see a gastroenterologist. We need to be mindful of our entire population.
The stool-based tests are a great option. FIT (fecal immunochemical test) is testing for the presence of blood; Cologuard looks for the presence of blood and genetic mutations. Both tests are done at home and sent to a lab, which sends the results to the ordering physician. We call this two-step testing: if the first step is positive, you will then be referred for a colonoscopy. If it’s negative, FIT testing is repeated yearly, and Cologuard every three years. (Colonoscopies are recommended every 10 years if no polyps are found.)
People with a strong family history of colon cancer or genetic syndromes that predispose them to polyps should probably forgo stool-based testing. For patients with inflammatory bowel disease, we do colonoscopies to make sure that inflammation over time doesn’t develop cancerous lesions. As of right now, there’s no reliable blood test for colon cancer screening.
Unfortunately, we don’t have enough gastroenterologists in the US to achieve a nationwide goal to screen 80 percent of patients using colonoscopy. Two-step testing is a way to screen more patients, and then, if needed, get them into a gastroenterologist for treatment.