- A colonoscopy is recommended every ten years for people over 45. Screening is used to detect colon cancer.
- But about 40 percent of eligible Americans don’t have a colonoscopy, often because they don’t want it.
- So what are the options? FIT and Cologuard stool tests can be just as effective, doctors say.
What if you didn’t have to have a colonoscopy every ten years between the ages of 45 and 75?
No, that’s no excuse to skip colon cancer screening, which has been proven to save lives. But there are several alternatives, which most people don’t know much about.
They’re called stool tests and they’re just as crude as you might imagine, but they can be done at home, mailed to a lab, and don’t require any special preparation like a colonoscopy.
Over time, stool tests — including fecal immunochemical tests, or FIT, and the much-heralded Cologuard — can be just as effective in saving lives, and they avoid some of the downsides of colonoscopies, experts say. The main problem with saddle tests is that they need to be done more often: FIT every year and Cologuard every three years.
No test is objectively better than the others. The U.S. Preventive Services Task Force also recommends colonoscopy and stool testing for people aged 45 to 75 and selectively up to 85 for someone who is otherwise healthy.
“The best colorectal cancer screening test is the one you actually choose to take,” said Dr. Barnett Kramer, a member of the Lisa Schwartz Foundation for Truth in Medicine, who retired as director of the division. prevention of cancer from the National Cancer Institute.
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Here are the pros and cons of the different approaches.
Advantages and disadvantages of colonoscopy
Colonoscopy is considered the gold standard. If someone has symptoms like bleeding or problems with other tests, people should have a colonoscopy to figure out what’s going on.
Routine colonoscopies should be done once every decade. Today,60% of Americans are up to date on colonoscopies, and an additional 11% choose a different testing method, according to the CDC.
Colonoscopies also have drawbacks.
Although the Affordable Care Act requires that colonoscopies, like other screening tests, be offered free to the patient, people are sometimes surprised by an anesthesia bill after a colonoscopy, Kramer said. (In China they often perform the procedure without anesthesia, but in the US most doctors will refuse to do one unless their patient is away and less likely to squirm due to discomfort, a he declared.)
Colonoscopies are arguably the best test for finding polyps, but it’s unclear what the goal of screening should be, said Dr Douglas Robertson, professor at Dartmouth Geisel School of Medicine and chief of gastroenterology. at the VA Medical Center in White River Junction. , VT.
“I don’t want to discourage people who have a history of polyps from going for exams and finding polyps,” said Robertson, who is leading a large trial comparing colonoscopy to FIT for the Veterans Administration.
Polyps are growths that may or may not turn cancerous, and more than half of the population have them.
“Common sense tells you that the vast majority of people, even with polyps, don’t walk to cancer,” he said.
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Cologuard stool test may be an option
Cologuard advertises extensively on television and has raised awareness of the need for colorectal cancer screening. This test, which requires people to take a sample of poo and mail it in, looks for certain high-risk genetic mutations as well as blood in the stool.
A positive Cologuard test could represent genetic mutations in the stool and this could prompt some doctors to do more follow-up testing even after a clean colonoscopy. But the need or the value of it the follow-up is not at all clear, Robertson said.
As a one-time test, Cologuard will detect more cancers than FIT, Robertson said, but over time, if done every year in the case of FIT and every three years for Cologuard, “it’s a call On the contrary, the models tend to favor the FIT,” he said.
Cologuard is easy for patients to use and easy for doctors to interpret, said Dr. Casey Allen, surgical oncologist at the Allegheny Health Network in Pennsylvania.
“There’s an incentive for the patient and for the provider,” he said.
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Why FIT may be the best of them all
FIT is very similar to Cologuard in that people often have to send in a stool sample, although some doctors may collect the sample with a rectal exam.
The main disadvantage of FIT, which only looks for blood in the stool, is that people have to take it every year, and some healthcare providers don’t trust their patients to keep up to date.
“When given the choice, the preference in some countries seems to be for FIT,” as opposed to colonoscopy or Cologuard, Kramer said. “I guess it’s less invasive and you can do it at home.”
About 5% to 7% of FIT tests will require a colonoscopy, compared to 13% to 15% of Cologuard tests, he said.
FIT is undeniably the cheapest option.
In a recent study, Allen and colleagues found that FIT cost just over $17 per year, while Cologuard cost Medicare about $350. (Private insurers are often charged significantly more.) A colonoscopy can easily cost $10,000. Under the Affordable Care Act, all drug tests must be covered by insurers.
“There are substantial cost savings without changing patient outcomes,” said Dr. Pavan Rao, general surgeon at Allegheny General Hospital, who led the research. “The driving force now is to provide education to patients and primary care providers…and educate them well on the costs versus the benefits of both tests.”
With Cologuard and FIT, the cost of a follow-up colonoscopy, if needed, may not be fully covered by insurance, as it is no longer a screening test, but a diagnosis.
In the future, insurers may require patients to share the costs of more expensive tests that have not been shown to be more effective than cheaper options, Allen said.
Major health care organizations, including the Veterans Administration and Kaiser Permanente, offer FIT testing, Robertson said, with Kaiser effectively encouraging people to come back every year. Kaiser has shown a 50% reduction in colorectal cancer mortality in his patients since they started using FIT in 2008.
Robertson and Kramer take annual FIT tests themselves.
“I’m a FIT enthusiast,” Robertson said.
Contact Karen Weintraub at kweintraub@usatoday.com.
Coverage of patient health and safety at USA TODAY is made possible in part by a grant from the Masimo Foundation for Ethics, Innovation and Competition in Healthcare. The Masimo Foundation does not provide editorial contributions.
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