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A Case for Not Pooping in a Box

Colon cancer is on the rise among younger adults (those less than 50 years old). One positive effect of the high-profile celebrity cases and deaths in the news is the public becoming more aware of the prevalence of colon cancer and understanding the importance of getting screened. But many people are resistant to having a traditional colonoscopy. This leaves the door open for less invasive options to woo potential patients. Commercials for the Cologuard home test kit play constantly on our televisions, promising to save patients the hassle of a colonoscopy. But is Cologuard really the best option? Or should you skip the box and go straight for the scope?

According to the National Cancer Institute (NIH/NCI) [1], in 2023, Colorectal Cancer (CRC) ranks as the 4th most common form of cancer (behind breast, prostate, and lung cancer) and the second leading cause of cancer death. The average age of diagnosis is 69 for women and 66 for men. These ages have dropped in just the last decade (for men, the average age has fallen from 72). And now, the recent wave of young adults diagnosed with the disease is dragging those numbers ever younger[2].

If you’re over 50, you have probably already had at least one colonoscopy. If you are getting screened regularly (every 5-10 years depending on your doctor’s recommendation based on your risk factors) you are doing one of the most important things you can to catch early-stage CRC.

But what happens if you are younger than 50? We are not normally screened for CRC before then. Setting aside whether our insurance company will cover a colonoscopy before the age of 50, most of us were not getting screened in our 40s unless there was an alarm sounded by our doctor. If you have a specific risk factor (overweight, sedentary, high alcohol consumption, a smoker), your doctor might mention changing your lifestyle and possibly prescribe one of the Cologuard poop-in-a-box test kits. Other than that, we don’t have to think about CRC until the moment we blow out all 50 candles on our birthday cake.

I was 47 when I received my diagnosis of colon cancer. And not early-stage colon cancer, like those in the 50+ group. I woke up from surgery to be told I had Stage-4C colon cancer. End of the line. I was not ready to pack up my things, check on my will, and start writing my goodbye letters. I was determined to beat this thing. Luckily, I had doctors around me who said things like, “don’t think in numbers,” and “this is not an automatic death sentence.” They led me to believe that anything was possible and that I could beat this thing.

Unfortunately, the statistics don’t back up my success story. And I call it a success story right now because one year beyond my diagnosis, my doctors have called me disease free. That is one small victory I will hold on to and enjoy. Many people under 50 aren't so lucky when they find out they have Stage-4CRC. Without regular screenings like our older counterparts, CRC can grow unchecked inside of us for years until the first symptoms appear. When someone under 50 is diagnosed with late-stage CRC, the most rational conclusion is that, without screenings, cancer grew for several years unchecked. Once CRC reaches the point where symptoms drive someone to seek treatment, it may already be too late.

CRC takes its sweet time with your bowel as it sends out the first little polyps. These grow slowly over the next 10-15 years. With a screening every 10 years, the hope is to catch those pesky little polyps before they turn into cancer. At 47, I should be able to look back to my 30s to find the root of my cancer.

The common symptoms of colon cancer: bleeding from the rectum; blood in the stool (or in the toilet) after a bowel movement; dark or black stools; change in bowel habits or change in the shape of the stool; cramping, pain, or discomfort in the lower abdomen; an urge to have a bowel movement even when the bowel is empty; constipation or diarrhea that lasts for more than a few days; decreased appetite; and unintentional weight loss.

I am the exact type of person who is not supposed to get CRC. I am healthy and very fit. I exercise for 90 minutes nearly every single day. I am vegan. I no longer drink alcohol or caffeine, and most importantly, I am a never-smoker. Many sources hypothesize that CRC in younger patients results from poor food choices, eating too many processed foods, consuming high fructose corn syrup, and the overuse of antibiotics. Although they have trouble pigeonholing patients like me, the researchers are now looking at how those factors played into our childhoods. With so many cases of late stage colon cancer in people in their 40s without obvious risk factors, researchers have no choice than to evaluate what sorts of environmental changes may have been occurring in the 1980s which in turn affected our developing bodies.

There is little comfort in not being alone in this late-stage diagnosis as a CRC patient under 50. The celebrity deaths from CRC come with mixed effects on the rest of us. With more money and resources than most of us, they still fell prey to a cancer that is not screened for until 50. Because they are high-profile individuals, their cases make the news. This is good. It should scare people. If a celebrity can die from this disease with all the advantages that their fame and fortune afford them, then what chance do the rest of us have? The best we can do is stay vigilant and get screened.

We like to look for reasons to avoid going to the doctor. Although someone may not have medical training, they like to refuse treatments because they may not understand their importance to their wellbeing, and don't see the value in spending money on them. It's common to avoid having a colonoscopy just because of fear of the bowel cleanse the night before. It’s simple: drink the stuff and poop your brains out. Yes, you’ll be hungry, but you will not starve to death in 24 hours. You’ll be ok. After you wake up from the sedatives, you’ll be ready to eat and start filling up your colon again.

Seeing the commercials for Cologuard, the at-home, non-invasive, through-the-mail, stool sample test, may make it tempting to ask your doctor to prescribe it, believing you'll be able to avoid a real colonoscopy. But be warned: Cologuard only detects 42% of large polyps, compared to a colonoscopy which detects 95% of large polyps. During a colonoscopy, the doctor can remove polyps immediately. But with Cologuard, you must go back for a colonoscopy anyway to have those removed. More frightening is that Cologuard cannot detect many precancerous polyps. Up to 10% of positive results are false, and even if you receive a negative result, your doctor will most likely send you for a colonoscopy anyway to confirm that the result is true. The older you are, the more likely you are to receive a false result (positive or negative).

With the cases of younger patients with CRC on the rise, the American Cancer Society has lowered the age of first colonoscopy screening to 45. Do yourself a favor and schedule yours right away. Don’t poop in a box, see your doctor. Most insurance will cover your colonoscopy, and if they don’t, tell the facility you need to pay cash and often you’ll receive a reduced price and a payment plan. Whatever the cost, trust me, it’s totally worth it.


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