Hi it's Dr. Jeffrey Mark. I've had a lot of questions recently regarding colorectal cancer screening, and people have asked about colonoscopy versus the fecal immuno testing fecal DNA tests or cologuard tests. Let me tell you a little bit about the differences, and why we still follow the general guidelines for colonoscopy. Colonoscopy is still the gold standard recommended by all the cancer societies and by the American Cancer Society, the American Medical Association, the American Society of Gastroenterology and also recommended by the American Society of Gastrointestinal Endoscopists. . So colonoscopy should be done every 10 years if there's no findings. we usually start looking at age 45 now that used to be age 50. We actually have moved things up earlier because we found people have had colon cancer at an earlier rate found even and there are cases in the 30s, and 40s but we start at 45 now. And if we had an unremarkable, study, and we would go every 10 years, the fecal immuno testing or fecal DNA the color guard is repeated every three years, if it's found to be negative, and negative result, meaning that the stool sample that's tested does not produce a positive value. Now, that does test for blood as well as DNA material that's suggestive of cancer, or malignancy. So the colonoscopy, usually, the main purpose is for detecting polyps, which are the earliest stages for colon cancer. Of course, many polyps are not cancers, but given 10 to 15 years of growth can become cancerous. So we we try to find them when they're small, easy to remove, less likely of a chance that they are cancers at that stage. The cologuard test of course is trying to detect if there is colon cancer, already, and there could be a miss rate of 8%. And it's not really designed to detect the pre cancers polyps. The detection rate is only about 42.4%, and it's not preventative., in that sense, it just answers the question specifically if you might have colon cancer, at which stage and if it's a positive test then you would proceed with the colonoscopy. Still the colonoscopy is considered the gold standard; detects colorectal cancers as well as the polyps, or the precancerous lesions as I described above. The procedure usually involves moderate sedation, although some prefer to have the equivalent of an IV general sedation which means that you can use propofol and pretty much be at a state where you're breathing for yourself but you're not aware of what's going on, and it's a pretty quick onset but then you wake up pretty quickly as well. Because your reflexes may be a little bit slow, we just don't want you to drive to the next day. Plan the procedure is very comfortable, especially with the profolol or moderate sedation. The fecal DNA test, of course, is painless in the sense that you just collect stool. The colonoscopy has had lots of data, it's been around for decades and it's been proven to actually save lives by picking up these precancerous lesions; the cologuard test is a new test it's only been around for a few years, and there are ongoing studies on trying to show its value, and there is value for those that cannot undergo colonoscopy if they have trouble with significant heart disease or pulmonary disease and can't tolerate a colonoscopy. And that's their only choice that would be good to screen or for those that declined colonoscopy. Colonoscopy is good for viewing family history of colon cancer or if you have a personal history of colon polyps or colon cancer, and that's because it picks up the polyps, which are the earliest stages of precancerous condition. That is why it's a preventive screening. The color guard test is not indicated if you have a family history of colon cancer, a personal history of colon polyps, a personal history of colon cancer or ulcerative colitis or Crohn's disease. Colonoscopy is best if you have symptoms, family history of colon cancer or personal history of colon cancer or colon polyps. And that's again because of the fact that you have higher risk of forming polyps and precancerous lesions which may need to be removed, the color guard is again is more specifically for colon cancer, abnormal genetic material, and by the time that's detected. you've already had either an advanced polyp or cancer. And for insurance purposes the colonoscopy if it's done as a preventative procedure is 100% covered with zero out of pocket expense if it's only for screening and you have a negative study. If, for insurance purposes you do the cologuard test in place of the recommended colonoscopy, the insurance will cover the cologuard test but if it is positive, and you need a colonscopy , that colonoscopy would no longer be covered at 100%, or have zero out of pocket costs because then that would be considered a diagnostic or investigative procedure to find out why you have a colon guard positive tests now, would not be considered screening. So hopefully these differences help clarify your options regarding colonoscopy and the fecal immuno testing DNA testing, which is the cologuard test. If you have further questions, feel free to email us at info @jeffreymarkmd.com, visit our website at www.allfunctionalhealth.com , or you can call us at area code 925-736-8228 or (209) 669-5000. Take care and stay healthy.
Jeffrey Mark, M.D.
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