If you shudder at the thought of a colonoscopy, you’re not alone. In fact, millions of Americans ages 45 to 75 aren’t getting screened for colorectal cancer when they should, according to the Centers for Disease Control and Prevention. That’s a problem: Colorectal cancer is the third-most diagnosed cancer in the United States. It’s also the third-leading cause of cancer-related deaths.
Last year, awareness around colorectal cancer surged when Chadwick Boseman, the actor who starred in Black Panther, died at 43. The disease is rare for people his age, but the rates are climbing, according to the National Cancer Institute. The tragedy of Boseman’s death is that colorectal cancer has a 5-year survival rate of about 90% when it’s caught early.
That’s why the U.S. Preventative Services Task Force recently updated its recommendation on colorectal cancer screening. The previous guidelines said that most people should begin routine screening at age 50. Now the group advises that screening should be offered at age 45 if you’re of average risk.
For years, colonoscopies have been the gold standard of screening. Doctors insert into your body a long, thin tube with a camera at the end. Using a video feed, they check your colon and rectum for suspicious growths or inflamed tissue. (Colonoscopies can be stressful, but affording your prescription medications shouldn’t be. Download our app to access savings through your phone.)
A few days before your colonoscopy, you will be asked to eat a low-fiber diet. Then the day before requires a liquid diet plus a thorough bowel-clearing. “We realize that not everyone is extremely excited about the prep,” says Mamta Kalidas, MD, a medical editor at the American Cancer Society. She’s also a voluntary oncology faculty member at Baylor College of Medicine in Houston.
Due to the inconvenience, many people delay or avoid colonoscopies. This is where stool-based screenings such as the fecal immunochemical test (FIT) come in.
How does the at-home FIT screening work?
It allows you to check your stool (also known as feces or poop) for blood. And you can do it without visiting a clinic or hospital.
The reason it works: Cancerous tumors often bleed. You may not see the small amount of blood when you look in the toilet after a bowel movement, but it can show up in a stool-based test. These tests might also detect blood coming from polyps, growths that occur in the lining of the colon or rectum, says Dr. Kalidas. Most polyps aren’t dangerous, but some can change into cancer over time.
With an at-home FIT, your doctor will order you a testing kit, which will arrive in the mail. It will include a long brush, a spoon or other collecting device, a test tube or card, a waste bag and a return mailing envelope.
FIT is noninvasive, meaning there’s no surgery involved and no tools will enter your body. And it requires zero prep. There’s no need to restrict your eating or drink bowel-clearing liquids. Just follow the instructions included in the kit to collect your sample. Then mail the kit back to the lab using the envelope and return address provided.
After your FIT results come in, your doctor will examine them and order a colonoscopy or other test only if necessary.
Is the FIT test right for you?
It’s a smart choice for many people — especially if you’ve been avoiding screening altogether. “The best screening test is the one that gets done,” says Lisa Ravindra, MD, an assistant professor of medicine at Rush University Medical Center in Chicago. The FIT test is relatively easy, and it can help catch colorectal cancer early.
And if you perform your FIT test as directed and go for follow-up exams as necessary, the CDC considers it as effective as a colonoscopy at improving life expectancy.
Still, it’s important to have a conversation with your doctor about your concerns and your risk for colorectal cancer before deciding which screening method is best for you.
The major difference between this at-home test and a colonoscopy is that the FIT does not diagnose cancer. So if you’re at an increased risk of colorectal cancer, your doctor may want you to stick with the gold-standard colonoscopy screenings. “That’s because the FIT may miss some early or precancerous lesions that a doctor would be able to spot and remove during a colonoscopy,” says Dr. Ravindra.
When deciding if FIT is right for you, some other factors to consider include:
- It needs to be performed every year, while a colonoscopy, if normal, needs to happen only every 10 years for people at average colorectal cancer risk.
- It may miss polyps or cancers.
- You can get a false positive, meaning it may detect blood, but that blood could be from a noncancerous condition, such as hemorrhoids or ulcers.
- You may still need a colonoscopy if the results are abnormal.
- For people at average risk, Medicare will cover FIT once a year or a colonoscopy once every 10 years. For people deemed high risk, it will cover a colonoscopy once every 2 years.
How do you know if you’re at a higher risk of developing colorectal cancer?
Your doctor will consider your age, family history, race or ethnicity and other health factors to determine your risk. And they’ll tell you when you should start screening and how often you need to repeat the process. While people with an average risk of colorectal cancer were previously told to start screening at age 50, the new recommendations align with the American Cancer Society’s advice to screen at 45.
If you have a family history of colorectal cancer, or a medical condition that may increase your risk, such as Crohn’s disease or ulcerative colitis, your doctor may have you start screening earlier than 45. (Attention, men: We put together a list of health screenings that could save your life.)
The growing trend in at-home testing
One side effect of the pandemic is that we’ve gotten used to doing more things at home: work, Zoom meetings, school, banking. And now there are medical screening tests too, says Dr. Ravindra. This could mean easier, less invasive screenings for years to come. (Shop the home tests available from Optum Store.)
While many colonoscopies and other in-person cancer screenings were canceled or missed during the pandemic, health plans began shipping kits such as FIT to patients who were due for a screening. OptumCare, for instance, sent 100,000 FITs to patients’ homes in 2020.
An alternative to the FIT is another stool sample test called Cologuard. It helps detect colorectal cancer by looking for blood and abnormal pieces of DNA from cancer and polyps. Other at-home health tests are available too, including saliva tests to check for genes that may put you at a higher risk of breast cancer or ovarian cancer.
The popularity of at-home tests has made them widely available — online, over the counter, even on Amazon. Still, Dr. Kalidas notes that it’s best to talk to your doctor first and have them order brand-name versions for you. “The ones that are online or over the counter sometimes won’t be covered by insurance, and we don’t know how well those particular tests have been studied,” she says. Having the results in your health care team’s hands also ensures that you’ll be supported, no matter the outcome.
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The benefits of at-home screening tests: JAMA (2021). “Pandemic spotlights in-home colon cancer screening tests”