Actor James Van Der Beek recently passed away after battling colon cancer. He was 48 years old. You will read how the American Cancer Society and other groups recommend that screening for colorectal cancer begin at age 45 with either traditional colonoscopy or stool testing[1]. Both of these recommendations are flawed. A better test exists. It's called virtual colonoscopy or CT Colonography.

Colorectal Cancer Rates

Colorectal cancer rates are increasing 1–2% annually in those under age 50[2,3]. Only 47% of the under-50 group is aged 45–49. 53% are under age 45. In other words, initiating screening at age 45 will miss more than half of the cancers arising in the age group with the most rapid increase in disease prevalence.

Limitations of Colonoscopy

Colonoscopy misses both colon cancers and polyps. Up to 1 in 4 significant polyps, known as adenomas, are not detected by colonoscopy[4]. Colonoscopy carries risk. 7 out of 100,000 people undergoing a colonoscopy will die from the procedure. 10 times that many, 70 per 100,000, will die within 30 days of the procedure. 4–5 of every 1,000 patients will suffer a significant complication other than death[5].

Real Numbers

Let’s put this into real numbers. Since over 16 million colonoscopies are performed annually[6], that translates into over 1,100 direct deaths, 11,000 deaths within 30 days, and 64,000 complications annually in the US. All of this from a screening test for which the vast majority of exams will be normal. Imagine if these same numbers applied to mammography, another screening test. No woman would agree to undergo the examination, nor should she. Yet we expect the public to accept the risk of colonoscopy.

Benefits of Virtual Colonoscopy

In the greater than 25-year history of virtual colonoscopy, no deaths have been reported worldwide. Complications approach zero—they are extremely rare. Equally important, virtual colonoscopy is the best test for finding colorectal cancers and the polyps that lead to colorectal cancer. At least 95% of cancers and 94% of the most important polyps are detected with virtual colonoscopy[7]. No other screening test exceeds these numbers. Stool tests are safe but poor at detecting precursor polyps, the real target of screening[8].

90% of patients who have a virtual colonoscopy will need no further testing for 5 years. 1 out of 10 will have a finding that requires a colonoscopy for removal. Because virtual colonoscopy is a low-dose CT examination, it can find other cancers and other silent medical problems. 1 out of every 300 virtual colonoscopy examinations detects an unsuspected non-colon cancer[9].

Virtual colonoscopy remains the best-kept secret in American healthcare. It’s time we changed that. It can save thousands of lives, avoid unnecessary injury and death from colonoscopy, and do so in the most cost-effective manner of any colorectal screening test.

References

  1. Wolf AMD, Fontham ETH, Church TR, et al. Colorectal Cancer Screening for Average-Risk Adults: 2018 Guideline Update From the American Cancer Society. CA Cancer J Clin. 2018;68(4):250–281.
  2. Siegel RL, Giaquinto AN, Jemal A. Cancer Statistics, 2024. CA Cancer J Clin. 2024;74(1):12–49.
  3. American Cancer Society. Colorectal Cancer Key Statistics. cancer.org. Updated January 2025.
  4. van Rijn JC, Reitsma JB, Stoker J, Bossuyt PM, van Deventer SJ, Dekker E. Polyp Miss Rate Determined by Tandem Colonoscopy: A Systematic Review. Am J Gastroenterol. 2006;101(2):343–350.
  5. ASGE Standards of Practice Committee, Fisher DA, Maple JT, et al. Complications of Colonoscopy. Gastrointest Endosc. 2011;74(4):745–752.
  6. Peery AF, Crockett SD, Murphy CC, et al. Burden and Cost of Gastrointestinal, Liver, and Pancreatic Diseases in the United States: Update 2021. Gastroenterology. 2022;162(2):621–644.
  7. Pickhardt PJ, Choi JR, Hwang I, et al. Computed Tomographic Virtual Colonoscopy to Screen for Colorectal Neoplasia in Asymptomatic Adults. N Engl J Med. 2003;349:2191–2200.
  8. Imperiale TF, Ransohoff DF, Itzkowitz SH, et al. Multitarget Stool DNA Testing for Colorectal-Cancer Screening. N Engl J Med. 2014;370:1287–1297.
  9. Pickhardt PJ, Kim DH, Pooler BD, et al. Colorectal and Extracolonic Cancers Detected at Screening CT Colonography in 10,286 Asymptomatic Adults. Radiology. 2010;255(1):83–88.