Screening vs. Diagnostic Colonoscopies: What’s the Difference?

Tak­ing charge of your health means lis­ten­ing to your body. From notic­ing how you are feel­ing to mon­i­tor­ing unusu­al symp­toms, check­ing in with your­self helps you get care when you need it. This is called diag­nos­tic care — or care used to fig­ure out what con­di­tion might be caus­ing your symp­toms.

Anoth­er impor­tant part of your health is called pre­ven­tive care. This involves keep­ing poten­tial health con­di­tions at bay by tak­ing steps to stay healthy, such as eat­ing a well-bal­anced diet, get­ting reg­u­lar exer­cise, and stay­ing up to date with screen­ing tests. 

When it comes to col­orec­tal can­cer, pre­ven­tive and diag­nos­tic care work hand-in-hand. While screen­ing colono­scopies are key to catch­ing prob­lems in their ear­li­est stages before symp­toms arise, a diag­nos­tic colonoscopy is nec­es­sary when symp­toms are already present. Screen­ing or diag­nos­tic approach­es are even more impor­tant if you have a per­son­al risk of col­orec­tal can­cer or cer­tain med­ical conditions. 

(SOURCE: https://​www​.can​cer​.org/​c​a​n​c​e​r​/​c​o​l​o​n​-​r​e​c​t​a​l​-​c​a​n​c​e​r​/​a​b​o​u​t​/​k​e​y​-​s​t​a​t​i​s​t​i​c​s​.html)

Here’s a break­down of colono­scopies, includ­ing the dif­fer­ence between screen­ing and diag­nos­tic tests, and when to get each one.

Col­orec­tal Can­cer and Colonoscopies 

Col­orec­tal can­cer is can­cer that begins in the colon or the rec­tum. Some­times, it’s referred to as colon can­cer or rec­tal can­cer, depend­ing on where the can­cer begins. How­ev­er, since the two can­cers have a lot in com­mon, they’re usu­al­ly grouped togeth­er as col­orec­tal can­cer.

Colono­scopies are one of the most effec­tive ways to low­er your risk of col­orec­tal can­cer.

Dur­ing a colonoscopy, your provider will insert a long thin flex­i­ble tube (known as a colono­scope) with a light on it into your rec­tum. These pro­ce­dures are typ­i­cal­ly done with seda­tion to ensure your com­fort and safe­ty dur­ing this exam. The goal of this test is to iden­ti­fy and remove polyps (pre-can­cer­ous growth which can some­times turn into can­cer) or diag­nose can­cer when present. 

Screen­ing Colono­scopies: When You Don’t Have Symptoms

When it comes to can­cer, the best-case sce­nario is to take steps to pre­vent it. A screen­ing colonoscopy is done when you don’t have symp­toms. This type of colonoscopy is high­ly effec­tive because most col­orec­tal can­cers begin as abnor­mal growths in your colon or rec­tum called pre­can­cer­ous polyps. These polyps can exist for years before ever turn­ing into can­cer. How­ev­er, they can also go unno­ticed because they don’t always cause symptoms. 

If your provider finds any of these polyps dur­ing a screen­ing colonoscopy, they can usu­al­ly be removed dur­ing the same procedure. 

Most peo­ple should begin reg­u­lar col­orec­tal can­cer screen­ing at the age of 45. Some peo­ple with high­er-risk fam­i­ly his­to­ries (fam­i­ly mem­bers with ear­ly col­orec­tal can­cer) or cer­tain med­ical and genet­ic con­di­tions may need to start their screen­ing soon­er than 45. It’s always impor­tant to dis­cuss your indi­vid­ual col­orec­tal can­cer risk with your trust­ed med­ical provider who can then help you deter­mine the best options for your care. 

If no polyps are found on the ini­tial screen­ing exam, screen­ing colono­scopies should be done every 10 years. If pre-can­cer­ous polyps (ade­no­mas) or can­cer are found on a colonoscopy, your med­ical provider may advise per­form­ing a sur­veil­lance colonoscopy for clos­er mon­i­tor­ing soon­er than 10 years. This is because there may be a high­er risk for future polyp for­ma­tion in peo­ple with a doc­u­ment­ed his­to­ry of polyps. Since some polyps devel­op and progress faster in some indi­vid­u­als, per­form­ing a sur­veil­lance colonoscopy soon­er (as advised by your provider) can help best ensure these growths are picked up and removed in their ear­li­est stages. 

Screen­ing and sur­veil­lance colono­scopies may con­tin­ue until age 76, at which point you should have a dis­cus­sion with your provider regard­ing your over­all well-being and health­care goals. For healthy seniors with well-man­aged med­ical con­di­tions, there may be a con­tin­ued ben­e­fit to col­orec­tal can­cer screen­ing up to age 85. Health­care goals can change as we age, and it’s impor­tant to dis­cuss these goals with your trust­ed med­ical provider.

If you need to sched­ule a screen­ing or diag­nos­tic colonoscopy, don’t wait. Make an appoint­ment with a Duly Gas­troen­terol­o­gist to pri­or­i­tize your col­orec­tal health. 

Diag­nos­tic Colono­scopies: When Symp­toms Arise

Unlike screen­ing colono­scopies, diag­nos­tic colono­scopies don’t fol­low a spe­cif­ic sched­ule. Instead, these stud­ies are per­formed when symp­toms arise or when need­ed for the man­age­ment of cer­tain med­ical con­di­tions.

Rea­sons for a diag­nos­tic colonoscopy include: 

  • Pres­ence of vis­i­ble blood in the stool
  • Pres­ence of invis­i­ble blood in the stool (usu­al­ly detect­ed by a stool test)
  • Inflam­ma­to­ry Bow­el Dis­eases (IBD), such as Crohn’s Dis­ease or Ulcer­a­tive Colitis
  • Unex­plained ane­mia (low blood count), par­tic­u­lar­ly with iron deficiency 
  • New changes in bow­el habits (either diar­rhea or constipation)
  • Wors­en­ing abdom­i­nal dis­com­fort or block­age symptoms 
  • Address­ing oth­er issues, such as plac­ing a stent or remov­ing objects in the colon

    Colono­scopies Are The Best Pre­ven­tion for Col­orec­tal Cancer

    Pre­vent­ing col­orec­tal can­cer starts with screen­ing. By stay­ing up-to-date with these effec­tive pro­ce­dures, you can catch abnor­mal­i­ties before they become can­cer or in their ear­li­est stages.

    You can also low­er your risk of col­orec­tal can­cer by mak­ing healthy choic­es every day. Some of these choic­es might include mak­ing health­i­er choic­es with eat­ing (empha­siz­ing fresh fruits and veg­eta­bles as able, and reduc­ing red meats or high­ly-processed foods), par­tak­ing in reg­u­lar phys­i­cal activ­i­ty, lim­it­ing alco­hol intake, and avoid­ing smoking. 

    Your health and well­ness should be just as much a part of your rou­tine as brush­ing your teeth in the morn­ing. Whether your colono­scopies are screen­ing, diag­nos­tic, or both, you can rest assured that you’re tak­ing steps to keep your colon healthy. 

    • It is an important part of my practice to pay thoughtful attention to the medical, emotional, and psychosocial aspects of each person’s care – as I often say to trainees working with me, “It is important to treat the whole person, not just parts of them.” I take pride in developing ongoing partnerships with patients and their loved ones as they work through each of these important aspects together.