"Most Americans hear colorectal cancer screening and think colonoscopy  the unpleasant cleanse the snakelike scope the wobbly ride home. Its a process thats undeniably inconvenient yet one were told is unquestionably necessary. Thats a shame. Because although colonoscopy certainly has its advantages direct evidence that its the best way to prevent deaths from colorectal cancer is not one of them.httpsfivethirtyeight.comfeaturesyoucouldskipyourcolonoscopyifyourewillingtocollectyourpoop And the drawbacks of colonoscopy  including the time commitment notsofun preparation expense and small chance of harm  are probably keeping some people from participating in colorectal cancer screening. According to public health experts thats a bad thing. The United States Preventive Services Task Force says the net benefit for screening adults age  is substantial adding that colorectal cancer is the secondleading cause of cancer death in the country. But as of  just  percent of eligible adults http were being screened as recommended and almost  percent had never been screened. Among those who are screened colonoscopy is by far the most popular method http in the U.S. But there is a menu of options http beyond colonoscopies  and theyre not necessarily any better or worse according to the USPSTFs recently finalized updated recommendations httpjama.jamanetwork.comarticle.aspxarticleid for screening among averagerisk adults.httpsfivethirtyeight.comfeaturesyoucouldskipyourcolonoscopyifyourewillingtocollectyourpoop The group said that while some tests are backed by more evidence than others it found no headtohead studies suggesting any strategy  including colonoscopy  is better than another. Choose the one that fits your preferences and lifestyle said Douglas Owens http a physician and member of the task force. Included on the list are two cheap athome poop tests intended to be done annually the guaiacbased fecal occult blood test gFOBT and a more sensitive test called the fecal immunochemical test or FIT. Both look for tiny amounts of blood in the stool that might be shed by cancer or polyps. You get one from your doctor take a poop sample at home and then return the sample to the doctor. Only if you get a positive result do you need to have a colonoscopy. These are different from a new stoolbased DNA test which while on the USPSTFs list is much more expensive and has been studied less. Of the two Richard Wender http a physician and chief cancer control officer of the American Cancer Society said the FIT is preferable both because its more accurate and because it requires only one poop sample and no changes in diet.httpsfivethirtyeight.comfeaturesyoucouldskipyourcolonoscopyifyourewillingtocollectyourpoop It costs about  or less and when done every year the USPSTFs models estimate httpjama.jamanetwork.comarticle.aspxarticleid it will avert  deaths from colorectal cancer per  people screened. Wender doesnt recommend the OTC tests that are available. Thats comparable to the two scope tests on the USPSTFs list flexible sigmoidoscopy and colonoscopy which have the advantage of both detecting and removing precancerous polyps in one procedure. Flexible sigmoidoscopy which looks at the lower part of the large intestine has been shown by randomized trials to prevent deaths from colorectal cancer but isnt reimbursed as well as colonoscopy and is on the decline in the U.S. Colonoscopy is the most popular test in the U.S. In addition to its polypremoving ability if you have a negative test you dont have to come back for another  years. httpsfivethirtyeight.comfeaturesyoucouldskipyourcolonoscopyifyourewillingtocollectyourpoop There is indirect evidence it reduces colorectal cancer deaths in the form of a large study http following people who did and didnt get the test over time. And it seems logical that if sigmoidoscopy cuts colorectal cancer deaths the more extensive colonoscopy must provide a similar benefit. But thats not yet been proved by randomized controlled trials.httpsfivethirtyeight.comfeaturesyoucouldskipyourcolonoscopyifyourewillingtocollectyourpoop Based on the available evidence and its modeling the USPSTF estimates it reduces deaths from colorectal cancer by  per  people screened. But that lack of trial data is why the Canadian Task Force on Preventive Health Care earlier this year recommended against httpcanadiantaskforce.cactfphcguidelinescolorectalcancer using colonoscopy as a firstline screening method. They were very clear Were going to stick to the evidence and right now we dont have evidence for colonoscopy said Aasma Shaukat http_Shaukat.asp section chief of gastroenterology in the Minneapolis VA Health Care System. Colonoscopy also has plenty of downsides. Its expensive running upward of . The test is covered without cost sharing as preventive care under the Affordable Care Act. Most people prefer to have sedation during the procedure which means time off from work and finding a ride home. Theres variation in the quality of the test depending on whos doing it. Theres a small but real risk of harm http such as a perforation. So why do so many people prefer it to the poop test For many because theyve been told its the best test to get. A  study found primary care physicians overwhelmingly said http they thought it was the best colorectal screening option. Katie Courics onair colonoscopy in March  boosted awareness and increased colonoscopy rates http Theres also a more is better attitude when it comes to medicine among many people said Shaukat. And colonoscopies are wellreimbursed for the physicians who perform them. Hospitals have focused on marketing colonoscopies http rather than alternative tests. No one is arguing colonoscopy is a bad test. It just hasnt been shown to be better than an annual FIT said James Allison httpprofiles.ucsf.edujames.allison a clinical professor of medicine emeritus at the University of CaliforniaSan Francisco. He said the public health message is slowly changing to reflect that. The  by  httpnccrt.orgtoolspercentby campaign from the National Colorectal Cancer Roundtable for example which aims to increase the rate of screening emphasizes a suite of options httpnccrt.orgwpcontentuploadsbyTALKINGPOINTSFinal...pdf. People are very motivated to get screened when they hear colorectal cancer is the secondleading cause of cancerrelated death and if they know there are tests that are affordable and can be done at home said Wender. So if you want a colonoscopy after talking with your physician and digging into all its pros and cons  fantastic. But if you prefer something less invasive but more frequent you can test your poop every year without feeling like youre opting for um No. ."