Dear Dr. Roach: Do home colon-cancer testing kits really help in the diagnosis of colon cancer? Do you recommend them?
E.F.
I strongly recommend colon-cancer screening for healthy people between the ages of 50 and 70. Based on other risk factors, some people need testing at a younger age, and for some, it might be appropriate to continue testing beyond age 70. Home tests have the potential to screen people who might otherwise be unable or unwilling to get screened in a doctor鈥檚 office.
In my opinion, the home test that combines a screen for colon cancer DNA and blood (multitarget test) is better than the fecal immunochemical test (FIT), based on a 2014 study showing better sensitivity. The multitarget test identified 92 per cent of the cancers found by colonoscopy. The home test isn鈥檛 perfect: Of all the positive test results, only about half had cancer or polyps and the remainder had no abnormalities.
Colonoscopy remains the best test, since it can find cancers and polyps, and they can be biopsied or even removed at the same time, thus preventing some polyps from ever becoming cancer in the first place.
However, there are many people who live in areas where routine screening colonoscopy isn鈥檛 available. There also are still some people who should, but don鈥檛 want to, get a colonoscopy. For these two groups, I recommend home testing, preferably with a multitarget test (such as Cologuard), as an alternative.
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Dear Dr. Roach: According to a CAT scan after a serious attack of abdominal pain some months ago, I have diverticulitis. I was treated with antibiotics. I had another attack recently and again was treated with antibiotics. But doctors are somewhat puzzled that my pain is on the right side of the abdomen instead of the usual left.
E.B.
Diverticula are small pouches in the colon, most commonly in the sigmoid colon, which is on the left side of the abdomen. When these become inflamed, it鈥檚 diverticulitis and so most people have left-sided pain. It鈥檚 not so uncommon to have symptoms on the right, though, either due to uncommon right-sided diverticula or, more likely, a redundant sigmoid colon (鈥渞edundant鈥� just means it is longer than usual and has a loop on the right side of the abdomen.
The other point I want to make about diverticulitis is that we internists often are too slow to ask our surgical colleagues to consult about treatment. Recurrent diverticulitis, when the disease is mostly confined to the sigmoid, can be effectively treated and recurrences prevented by removing the affected portion of the colon. This obviously isn鈥檛 right for everybody, but it is an option worth considering for people with multiple recurrences.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected].
