If you’re over the age of fifty, you’ve probably had a colonoscopy. Most doctors recommend routine colonoscopy every ten years to screen for colon cancer. Colon cancer is the second leading cause of cancer-related deaths in the U.S. Approximately one in 23 men and one in 25 women will be diagnosed with colorectal cancer in their lifetime according to the American Cancer Society.
Cologuard is a non-invasive test to screen for colon cancer that only requires providing a stool sample in a specially prepared container for laboratory analysis. This test looks for abnormal cell DNA shed in the stool, which can be an indication of cancer. Cologuard is advertised frequently in the media as an alternative to colonoscopy for low-risk patients. Barium enema is also done as an alternative to colonoscopy in some patients, particularly those who have abdominal adhesions that impair the ability to safely perform colonoscopy.
What other alternatives are available?
Amy Denney, writing in The Epoch Times, tells us of another option. She says, “Offering patients options to test for colorectal cancer may be a good strategy, according to the results of a study by Kaiser Permanente researchers presented at Digestive Disease Week. Investigators in this 20-year population-based study sent at-home kits for fecal immunochemical testing (FIT) and colonoscopy reminders to patients overdue for colonoscopies.”
“If you offer people more than one option for screening—such as colonoscopy or FIT—they’re more likely to get screened than if you offer either option by itself,” Dr. Douglas Corley, researcher and gastroenterologist, said in a news release. “To get above an 80 [percent] screening rate, you almost always have to offer people multiple options.”
What is FIT?
FIT tests are a noninvasive way to determine whether people have blood in their stool. People with positive tests should then follow up with a colonoscopy. FIT tests in particular are a great way to reach both patients who live in rural areas and young adults, who are experiencing more incidents of colorectal cancer even as the overall incidence declines, Corley said in an American Medical Association update.
“So there are a lot of positives about it,” he said. “And that’s one of the reasons why the U.S. Preventive Services Task Force kind of equally recommends colonoscopy and FIT for benefit in terms of decreasing the risk of death from colorectal cancer.
I first learned about FIT testing from my gastroenterologist. He expressed no confidence in the accuracy of Cologuard testing but was much more impressed with the results of FIT testing. He uses FIT when colonoscopy cannot be performed safely.
Screening rates—via colonoscopy, sigmoidoscopy, or FIT—grew from 37.4 percent in 2000 to 79.8 percent in 2019 across all racial and ethnic groups, according to the researchers. Giving patients more options in the type of colorectal cancer screening they received—including a FIT test mailed to their home—reduced the number of those who got cancer by one-third; reduced deaths by one-half; and eliminated nearly all the racial differences in screenings, diagnoses, and deaths.
Colorectal cancer deaths decreased by about 50 percent in the Kaiser Permanente study with the largest reductions seen in black patients who have historically had worse outcomes from colorectal cancer. Deaths among black patients declined from 52.2 per 100,000 to 23.5 per 100,000.
Colonoscopy is still the gold standard for detecting colon cancer. But FIT is a suitable alternative when colonoscopy cannot be performed, especially in low-risk patients. Ask your doctor about FIT instead of Cologuard next visit.
