Is the stool test at home an alternative to colonoscopy?

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 testing for FITs – 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.

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 necessarily 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.