Sunday, November 27, 2011

Fecal DNA for Colon Cancer Screening and Cleaner Sidewalks: Which Matters More?

It’s Saturday morning, and I’m in an undisclosed location drinking a fabulous cup of coffee while turning the pages of The New York Times, knowing that ink and newsprint will be vanishing too soon. Yes, I do have an iPad now, but I haven’t figured out how to blog on it. Any suggestions?

Buried in the first section of the paper is an article on stool, which in my view as a gastro specialist, should have merited front page placement. Yes, we all know the adage, ‘one’s man’s trash is another man’s treasure’, but stool - as in excrement - should be prized by everyone. Perhaps, as a gastroenterologist, I have a jaundiced view on this issue, which explains my dyspeptic reaction.

All Whistleblower posts have an accompanying image, and I wonder what visual would be appropriate here.  I opted against my first choice, and chose instead a photo of our beloved Labrador Retriever, Shoshie, of blessed memory.

The Times reported a new program to trace canine unscooped poop back to Spot’s owner. Several apartment complexes around the country are now participating. All dogs residing there will submit a DNA sample that will be forwarded to data base. Hopefully, the mailing containers will be secure. It is not clear if a fecal sample can be acquired without obtaining canine informed consent, documented with a paw print, but until the courts rule on this issue, doggie cheek swabbing will continue.

Here’s how it works. If a pedestrian steps in the wrong place, as in ‘glitch’, then a sample from the bottom of the soiled shoe can be mailed to the Turd Squad to determine if there is a DNA match in the data base. If a connection is made, then the pet’s owner will be properly shamed and sanctioned.

Of course, howls of protest will erupt from barking pet owners who will challenge the company’s scientific credentials, or will claim that they were set up by landlords who were seeking back rent. Hey, Dick Wolf, is there a new version of Law and Order Here? How ‘bout, Law and Order: Excremental Intent?

I love seeing gastroenterology making an important difference in people’s lives.

Fecal DNA, I anticipate, will be doing much more for us than keeping our sidewalks a little cleaner. This technology may be the force that transforms colonoscopy from its position as the premier instrument to investigate the colon and to prevent colon cancer into a museum piece. I suspect that that this transformation will occur sooner than we all think.

While the FDA (Food and Drug Administration) has not approved fecal DNA testing for colon cancer screening, professional societies including The American Cancer Society, the U.S. Multi-Society Task Force on Colon Cancer and The American College of Radiology all endorse stool DNA testing as a screening alternative.

In the coming years, there will be a parking lot rumble among competitors who will argue that their colon cancer screening is best. I think screening colonoscopy has some good years left, but this is not the future. Fecal DNA promises to be one mean screening machine.


  1. Crap, now you tell us. And I have one of these damn things scheduled for next week. I'm going to have my girl friend read this. She's been on my case now for over a year to get this done. Maybe I can get a continuance. Fecal DNA sounds like a much more comfortable option. Thanks for the heads up Doctor.

  2. Wouldn't opt for the continuance. You might end up in the 'dog house'. Good luck!

  3. Awesome article. Perhaps CHP can help collect the stool samples! :)

  4. The FDA has now approved a DNA-based stool test called Cologuard. Where does it fit as an option for colorectal cancer screening? Would you recommend it?