El futuro de la detección del cáncer colorrectal: Alternativas a la colonoscopia

It’s a common scenario: you’ve had your annual exam, but you keep putting off scheduling that Colonoscopia or additional tests your doctor might have ordered. Life just gets so busy, and this is yet another thing to add to the to-do list.  

But you’re in good company, according to the Centers for Disease Control and Prevention (CDC), about 30% of adults aren’t up to date on their recommended colorectal cancer (more commonly known as Cáncer de colon) screenings.

Here’s something that might change your perspective—colorectal cancer is the fourth most common cancer diagnosed in both men and women in the United States, according to the American Cancer Society and National Cancer Institute, after breast, prostate and lung cancers.  

It's also one of the most preventable cancers when caught early through regular screening. In recent years, the recommended age to start screening has gone down for average-risk individuals. The American Cancer Society now recommends regular screening starting at age 45 instead of 50 for people at average risk. If you’re 45 or older and haven’t been screened, it’s time to talk to your doctor about your options.  

If you’re hesitant to get a colonoscopy, that doesn’t mean you should avoid screening altogether. There are other procedures and tests that may help detect colorectal cancer, too.

Understanding the colorectal cancer screening test

Colorectal cancer screening works by detecting cancer in its early stages when it's most treatable, or even better, by finding and removing precancerous polyps before they become cancerous. The key is consistency—regular screening according to your doctor's recommendations gives you the best protection.

The American Cancer Society now recommends that people at average risk begin colorectal cancer screening at age 45, though your doctor may suggest starting earlier if you have certain risk factors like a family history of colorectal cancer, inflammatory bowel disease or certain genetic conditions.

The two main groups of screenings include the following:

1. Procedure-based tests that provide a direct view of the colon (such as a colonoscopy)
2. Indirect tests that use labs or imaging to look for cancer (such as a FIT test)

Here, we’ll review some of the many colon cancer screenings available today, including their advantages and disadvantages.

Procedure-based, direct colorectal cancer screening

Colonoscopia

Colonoscopy is probably the most well-known screening test for colon cancer. It remains the “gold standard” due to its sensitivity in finding both cancer and pre-cancerous polyps, as well as its ability to identify them accurately. It’s also the only test that is preventive. We can detect small polyps and remove them at the same time. If you’re not sure what to expect during a colonoscopy, read our colonoscopy guide for more information.

Las ventajas incluyen:

• Solo se necesita cada 10 años para quienes tienen un riesgo promedio
• Le da a su médico una vista directa de todo el colon
• Muy preciso para encontrar cáncer y pólipos precancerosos
• It can prevent colon cancer by removing polyps during the same procedure

Las desventajas incluyen:

• Requiere una dieta especial y preparación intestinal antes del procedimiento
• Requiere tiempo fuera del trabajo
• Realizado bajo sedación
• Viene con pequeños riesgos en comparación con otras pruebas indirectas

Sigmoidoscopia flexible

This less-common procedure is like a mini-colonoscopy that examines the last third of the colon. It’s recommended every five years or every 10 years if used together with a stool-based test. It can be done without sedation, but still requires bowel prep the day before. Because it doesn’t examine the entire colon, this isn’t the preferred screening for most people.

Stool-based, indirect colorectal cancer screening

Prueba inmunoquímica fecal (FIT)

Una prueba FIT es el método de detección de cáncer de colon basado en heces más recomendado. Puede recolectar una muestra de heces en casa y enviarla para su análisis. Luego, la prueba busca pequeñas cantidades de sangre en las heces que puedan indicar cáncer o un pólipo.

Las ventajas incluyen:

• Fácil de realizar en casa.
• No requiere tiempo libre en el trabajo
• Sin riesgos como los asociados con un procedimiento
• Menos costoso para quienes no tienen cobertura de seguro

Las desventajas incluyen:

• Must do it every year
• Not as sensitive as a colonoscopy at detecting cancer
• Not as useful for preventing cancer, since small polyps may go undetected
• Will still need a colonoscopy if positive

FIT más prueba de ADN

Esta prueba toma la prueba FIT y agrega una capa de prueba genética. Se hace cada tres años. Además de la sangre, la prueba busca ADN anormal de pólipos o células cancerosas en las heces. La principal desventaja de la prueba es el potencial de falsos positivos. También tiene un costo ligeramente más alto que FIT para quienes no tienen seguro.

Colonografía por TC

A veces llamada colonoscopia virtual, esta prueba utiliza una tomografía computarizada para examinar el colon y se recomienda cada cinco años. El procedimiento no requiere sedación y conlleva un riesgo ligeramente menor que una colonoscopia. Sin embargo, al igual que la colonoscopia y la sigmoidoscopia flexible, aún se requiere una preparación intestinal para limpiar el colon.

Pruebas indirectas adicionales

There are other, less widely used colon cancer screening tests. However, many of them are not as sensitive or specific in detecting cancer. For example, even a simple blood test can look for markers in the blood that may indicate colon cancer, but some of these tests may not be covered by insurance. Options like colon capsule endoscopy, which uses a small pill camera, also aren’t widely used.

Cuándo considerar alternativas a la colonoscopia

Es importante tener en cuenta que las alternativas a la colonoscopia no son para todos. Si tiene antecedentes familiares de cáncer de colon, antecedentes de pólipos de un examen anterior, ciertos síndromes genéticos o ciertas afecciones médicas como la enfermedad inflamatoria intestinal, aún necesita una colonoscopia, y la edad y el momento de su examen pueden ser diferentes.

However, if you are at average risk and you’ve been putting off a colonoscopy, talking to your doctor about alternatives might be a good first step. Both colonoscopy and FIT are considered the top options to help detect colon cancer, although other use-at-home collection kits are being ordered by physicians as well.

The key is to have the conversation and get a screening for this highly detectable condition. When it comes to protecting yourself against colon cancer, some type of screening is better than none.   

Learn more about colon cancer and talk to your doctor today about what screening option is best for you.