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A simple stool examination at home is a reliable way to screen for colon cancer – and a good alternative to invasive colonoscopies, a new study confirms.
The analysis, out of 31 studies, focused on the efficacy of the stool immunochemistry test, or FIT, which detects the presence of hidden blood in the stool. It was found that a single FIT screening involved up to 91% of colon cancers in people at average risk of contracting the disease.
Experts said the results offer more support for a screening test that has long been a recommended option – but that is not often done in the United States.
Instead, most Americans undergo colon cancer screening by colonoscopy – an invasive test that examines the colon. However, many other countries are in favor of an annual stool test.
"For the average person at risk, there are good alternatives to colonoscopy screening, and people should be aware of it," said Dr. Thomas Imperiale, principal investigator of the study. "It's the bottom line."
Imperiale is a gastroenterologist at the Indiana University School of Medicine and the Regenstrief Institute in Indianapolis.
He explained that, according to his experience, patients sometimes undergo a colonoscopy without ever having heard of other options from their attending physician.
"I think we need to be more forthright with patients about all their options," said Imperiale.
The results were reported online on February 26 in Annals of Internal Medicine. They are based on more than 120,000 patients who have undergone FIT screening and subsequent colonoscopy.
Being filtered, it matters
For FIT screening, a doctor provides a test kit that patients can use at home. Different manufacturers manufacture FITs. According to the review, the review found that a single screening detected about three quarters to 91% of colon cancers.
This makes a single FIT less sensitive than a single colonoscopy. But, said Imperiale, FIT screening is done every year, while colonoscopy is done every 10 years.
In addition, some people who are not willing to have a colonoscopy could quite well have a stool test. And that's the screening that matters, said Imperiale.
An editorial published with the study indicates some precise figures: Only two-thirds of Americans aged 50 to 75 years were screened for colon cancer, mainly by colonoscopy. Of the one-third of the undetected, many are low-income, uninsured or "underinsured".
Increased awareness of cheaper and easier FIT screening – in both physicians and patients – could help narrow this gap, said Dr. James Allison, the author of the editorial team.
For years, Allison said, the media and health systems have encouraged colonoscopic screening as a "gold standard," while FIT is often considered the "second choice."
But the evidence does not support that.
"There is no optimal test for colon cancer screening," said Allison, who works for the University of California San Francisco and the Kaiser Permanente Northern California Research Division.
And, he said, the guidelines on colon cancer screening do not recommend any tests over others.
At least as good as colonoscopy
According to the guidelines of the American Task Force on Prevention Services, people at average risk of colon cancer should start screening at age 50. The American Cancer Society suggests doing it at age 45. test).
Colonoscopies are much better than FIT for detecting polyps – benign tumors that sometimes become cancerous. However, said Imperiale, research suggests that large "advanced" polyps become cancer at a rate of 3 to 6% per year. So, if a FIT misses a big polyp, there is a good chance that it is still caught in subsequent tests.
And while colonoscopies are generally safe, they carry a low risk of bleeding, infection, or tearing of the bowel.
"We have to recognize that FIT is at least as effective as colonoscopy," Allison said.
There is another type of stool-based screening test called Cologuard. It looks for both hidden blood and some changes in DNA that can be found in colon cancers or polyps.
But the test is expensive – about $ 500 – and there is no evidence that it's better than FIT testing, Allison said.
People who choose to have a stool test will not be able to avoid colonoscopy. If blood is detected, you will need a follow-up colonoscopy, which can turn out to be a false alarm. It is also essential to respect the annual calendar, said Imperiale.
Image credit: iStock
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