At-Home Colorectal Cancer Tests, Colonoscopies and You

Mail-in screening options are a step in the right direction.

Colorectal cancer is the second leading cause of cancer deaths among men and women in the U.S. Fortunately, there’s an excellent method to screen for it: a colonoscopy. The procedure can find the cancer early, when it’s most treatable. It can also prevent it altogether through the removal of precancerous growths called polyps.

Colonoscopy has a 96 percent rate for finding polyps 10 millimeters or larger in diameter. When polyps of all sizes are included, a colonoscopy has an 89 percent polyp detection rate. Yet, according to 2013 data from the Centers for Disease Control, more than a third of American adults ages 50–75 were not screened for colorectal cancers in the preceding decade.

Why do people avoid colonoscopies?

Stop Colon Cancer Now, a community of physicians that promotes education and awareness about colon cancer screening, researched the exact reasons in 2015. The organization asked 1,100 at-risk adults (both men and women) who never had a colonoscopy why they didn’t schedule the test.

Respondents cited reasons including:

• 28 percent did not believe it was necessary
• 20 percent believed it was too expensive
• 20 percent “disliked” the way the procedure is performed
• 16 percent said they use other methods to avoid colon cancer

The most worrisome statistic? A combined 13 percent said that they either did not know they needed one, or that they were “too busy” to get one.

Current screening recommendations

Screening target rates of Healthy People 2020, an initiative from the U.S. Preventive Services Task Force, recommend a fecal occult blood test (FOBT) annually, a sigmoidoscopy every 5 years and FOBT every 3 years, or a colonoscopy every 10 years. Colonoscopies and sigmoidoscopies make use of a flexible, thin tube to look inside the colon. A tiny camera is attached to the end of the tube.

 “People at increased risk should consult their doctors about more frequent screenings,” says Dr. Daniel A. Sussman, a clinician and researcher of colorectal and gastrointestinal cancers at Sylvester Comprehensive Cancer Center, part of the University of Miami Health System. “You are at greater risk if you have had colorectal cancer, polyps, or ulcerative colitis in the past; if you have a family history of colorectal cancer, polyps or a hereditary colorectal cancer syndrome.”

What about mail-in screening tests?

At-home colorectal cancer screening tests, available by prescription, have been developed. But just how accurate are they? And are they right for your health needs? Current varieties include: 

• Multi-target stool test: Approved by the U.S. Food and Drug Administration in 2014, this test analyzes the DNA in a stool sample you send into a lab. These tests also check for blood in the stool, which can be an indication of cancer or polyps.
• Fecal immunochemical test (FIT): This test specifically looks for blood in the stool.
• Guaiac-based fecal occult blood test (gFOBT): This test also checks for blood in the stool. However, its results can be negatively impacted by a range of foods and medications.

“Overall, these stool-based tests are nice options for patients,” adds Dr. Sussman. “When results from these tests are positive, a colonoscopy should be scheduled to find out why the stool tests were abnormal.”

Dr. Sussman shares that some of the tests are still fairly new, and not all are financially covered by insurance companies. The at-home tests also are not recommended for patients who are at a high-risk of colorectal cancer (see above) or for those who have worrisome symptoms, like rectal bleeding or undesired weight loss, or the sign of unexplained anemia. Colonoscopy is the best option for these patients who are at increased risk for colon polyps or colon cancer.

Not sure about which screening method is right for you? Talk to your doctor. Or call Sylvester Comprehensive Cancer Center for advice or a screening appointment at 305-243-1000 or 800-545-2292.

John Senall is a contributing writer for the UMiami Health News Blog. He is a former hospital and comprehensive cancer center communications director.

Tags: cancer, colonoscopy, colorectal, Dr. Daniel Sussman, fecal-occult blood tests, Sylvester Comprehensive Cancer Center