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The Great 25 Cent Medical Test

My wife was first to notice something was the matter with my father. "He's tired all the time," she said. "He's always asleep on the couch."
"Well, he's seventy," I said, writing off her observation to my father's old age.

I reminisced about how hard my dad worked when I was a child. He was up and gone before I awoke for school. He came home late. And after dinner, he often fell asleep on the couch. Now retired, nearly thirty years later, I felt he deserved all the rest he wanted. But after my wife's comments, I took greater notice. My dad was tired all the time, and he seemed somewhat pale. So I brought him to my hospital and had a doctor friend examine him.

When it comes to the diagnosis and screening of disease, medicine relies on lots of expensive gadgetry. Machines which cost millions perform tests that cost thousands. But there is one diagnostic tool, smaller than a credit card, which costs about 25 cents, that screens for a malignant disease that will occur in about 5% of all Americans. The tool is made of cardboard. It's called a "fecal occult blood test." It screens for "occult" or hidden blood in the stool. This simple test led my father's doctor to the right diagnosis. My dad wasn't simply old and tired. He had colorectal cancer.

There are 150,000 new cases of colorectal cancer diagnosed in this country every year, and 60,000 deaths. Just being an American may be a risk factor since the average American diet, low in fiber and high in fat, is associated with high colon cancer rates.

Fecal occult blood testing is not a panacea. Having no blood in the stool does not assure the absence of cancer. Only about 32% of pre-cancerous polyps bleed before becoming cancers. And the test can be deceiving. Rectal bleeding from hemorrhoids or fissures will turn the card positive. And simple drugs like aspirin or Advil can cause mucosal bleeding and a positive test.

My father's positive screening led to strong suspicion of a lesion in his bowel. Colonoscopy, the use of a flexible scope to examine the large bowel, is the diagnostic procedure of choice. Not only is the gastroenterologist able to visualize a lesion, he can biopsy the tissue and even remove polyps through the scope.

My father's cancer was found early and he underwent surgery to remove the diseased part of his colon. He's alive, well, and seventy-six this year.
For those with a family history of colon cancer, like me, yearly fecal occult blood tests beginning at age 40 and colonoscopy at that age and every five years after is suggested. The American Cancer Society also advises annual fecal occult blood testing and a screening sigmoidoscopy every three to five years for people over 50. Scoping is important since up to 60% of lesions can remain undetected if occult blood testing is the only screening method.

My dad still falls asleep a lot on the couch these days, and he deserves to. I'd like to sleep there more often myself, but my wife won't let me. She thinks she's the doctor. I guess when it came to saving my dad's life, she was.