Colonoscopy is the gold standard for colon cancer screening, but getting one may be challenging for some people.
In addition to the financial barriers if you don’t have good insurance, patients may avoid getting screened for colon cancer because they don’t want to be put under anesthesia while a doctor uses a camera at the end of a flexible tube to scan the colon and large intestine for abnormalities.
And that comes the day after the prep, during which you can have only clear liquids and must drink a less-than-pleasant liquid to clear the intestinal tract.
“The prep is never as bad as the comedian makes it sound,” said Greg Seltzer, the medical director of gastroenterology for Virtua Medical Group. Still, it’s no one’s idea of fun.
Seltzer recommends colonoscopy to most patients needing to be screened for colon cancer because any polyps (small masses of cells that could become cancerous) can be removed right away. If no problems are found, you won’t need another one for 10 years.
“This is one of the rare cancers where we know we can prevent it,” he said.
Stool DNA and FIT kits are at-home alternatives to colonoscopy
At-home tests have grown in popularity — you can hardly turn on the TV news some evenings without seeing the little cartoon character with one brand prancing around. And in Philadelphia, doctors see home tests as a way to increase screening rates. They could be especially useful for people who won’t or can’t get a colonoscopy, or who are in the 45-50 age group and new to the recommendation.
In a study published in the Journal of General Internal Medicine last year, Shivan Mehta, a gastroenterologist and associate chief innovation officer at Penn Medicine, and his colleagues found that mailing at-home test kits to patients increased screening compliance tenfold.
Through a text message “opt-out” system, patients were notified that they’d be receiving a test kit — unless they said they didn’t want one.
The two most popular types of at-home tests are:
Fecal immunochemical tests (FIT), which require the user to collect a stool sample and send it to a lab, where it is tested for hidden traces of blood. Blood in stool is one potential sign of colon cancer.
Stool DNA test, which analyzes a stool sample taken at home and sent to a lab for DNA changes that could indicate colon cancer.
Both types of tests are done at home with little or no preparation and are noninvasive. And if you’re paying out of pocket, FIT kits can cost as little as $25. The most well-known stool DNA test, Cologuard — that’s the one you may have seen on TV — costs about $600.
Drawbacks to at-home tests
FIT tests must be repeated annually, while stool DNA tests are done every three years. Medical experts say people who have a higher risk of colon cancer (for instance, if they have a family history) should stick with colonoscopies. And if the home test detects something unusual, patients will need to have a colonoscopy to find out what’s happening.
In the past, insurers could bill patients who got a suspicious result from a home test for the follow-up colonoscopy, because it was deemed diagnostic — performed to get more information on a known problem — rather than considered a screening test. Federal guidelines have recently clarified that a colonoscopy needed as follow-up to an at-home screening test should be considered part of the screening process, but Mehta urged people to check with their insurance company to confirm how their plan covers such scenarios.
Still, with some screening centers still catching up on appointments delayed during the pandemic, plus patients younger than 50 needing first-time screening, the at-home tests are efficient, said Michael Goldberg, chair of the division of gastroenterology at Einstein Healthcare Network.
“The best test is the test that gets done. That’s the most important thing,” he said.