Colonoscopy remains the gold standard, but home screening is an option for low-risk people, experts say
By Deborah Jeanne Sergeant
As a general rule, most people 50 and older should receive colon cancer screening. But the liquid diet and laxatives required for colonoscopy, followed by an exam that can include sedation and a rectal probe, deters some people from receiving the lifesaving screening.
Colon cancer is a largely preventable cancer since colonoscopy can detect pre-cancerous polyps and include remove of them. Current compliance with colon cancer screening is about 50 percent nationwide — but home colon cancer screening kits may change that.
Available since about five years ago, the fecal immunochemical test (FIT) screening involves taking small fecal samples at home. Users do not need to make dietary changes in advance or perform the test at a doctor’s office. They simple mail in the samples and await the lab results. The test looks for blood in the stool, a common sign of polyps. When stool leaves the body, it tends to bump into polyps, which resemble large grapes on a stem. When polyps move, they often bleed a little. Though the blood is often invisible in the stool, the test can detect it, along with other evidence of colon cancer.
“Any test is better than no test,” said Michael Sapienza, president and CEO of Colon Cancer Alliance in Washington, DC. “The colonoscopy is the gold standard, but you have to look at the actual number of people who will do the test.”
One of the disadvantages of the FIT is that it must be repeated annually. People with average risk of colon cancer need return for a test every decade after their initial test shows no polyps.
A person whose FIT comes back with questionable findings must proceed with a colonoscopy at that point. Those who receive colonoscopy can have polyps removed before they awake from sedation.
“Normally, this is a disease affecting people over 50, but over the past two decades, we’re seeing a 2 to 3 percent increase every year in people who are younger and being diagnosed with colon cancer,” Sapienza said. “But screening is only covering people over 50. If you have cramping, night sweats, change in the size of stool, or blood in your stool, ask for a screening.”
Most people should begin screening at age 50, unless they have a first-degree relative diagnosed with colon cancer under the age of 50. In that case, the patient should begin screening 10 years before the age of their relative at the time of diagnosis. Blacks should begin screening at 45, and people with bowel issues such as irritable bowel syndrome, colitis, or diverticulitis.
“Talk with your doctor,” Sapienza said “There are a lot of things that could potentially make you a candidate to go in earlier.”
If you lack sufficient insurance to cover the cost of colonoscopy or other screening method, community organizations may help, such as Cancer Services Program of Erie County. Michelle Wysocki, program coordinator, said that the organization offers free FITs for people of average risk.
“There was a home collection kit that required change in diet and a lot more effort,” Wysocki said. “It was a tough sell and hard to get the kits returned, because people found it hard to do. FIT doesn’t require a change in diet. It’s more readily accepted by people who don’t even want to hear about colonoscopy. It’s effective and readily acceptable.”
Rather than offer only colonoscopy, the most costly screening, the FIT can save money on the majority of people who won’t need polyps removed.
Wysocki said that only roughly 10 percent of participants using the FIT must come back for a follow-up colonoscopy, and not all of those have colon cancer.
“Why put them all through the more invasive and costly test?” she said. “Colonoscopy is a medical procedure. It has its place and is the gold standard of screening but there are other tests.”
In Erie County, the Cancer Services Program offers cancer screenings, including the FIT, for those who have limited or no health insurance. The organization also distributes free FITs to anyone on select days at Tops stores throughout the county.
Free Colon Cancer Home Screening
If your insurance won’t sufficiently cover colon cancer home screening, visit Tops in March to pick up a free FIT from 4 to 7 p.m. on one of the dates below:
1275 Jefferson Ave.
425 Niagara St.
1740 Sheridan Drive
3500 University Plaza
4777 Transit Road
9660 Transit Road
S. 6150 South Park Ave.
3201 Southwestern Blvd.
150 Niagara St.
890 Young St.
355 Orchard Park Road