Non-invasive colon cancer screening options?

January 25, 2022 11:37 AM

With the understanding that a colonoscopy is still the gold standard for detecting colon cancer, are there any acceptable (or good?!) non-invasive options that are accessible to consumers at this time?
posted by Forty-eight to Health & Fitness (16 answers total)

There's a mail-in test. In Ontario the government mails one to every person over a certain age every year(?) I think. You smear your poop on a card and send it in. I feel like I've seen this advertised on CNN so it should be available in the US, if that's where you are. Presumably, since they're advertising, it's something you can just buy. I should add, I think this is more screening than diagnostic. You're still supposed to get your colonoscopy every 5 years, it's just if the mail-in test shows anything, you get a colonoscopy even sooner.
posted by If only I had a penguin... at 11:39 AM on January 25, 2022

When my insurance wouldn't cover a colonoscopy, my primary care doctor ordered this one. It had vials to send in rather than a card.
posted by *s at 11:44 AM on January 25, 2022

Pinnacle BioLabs sells a home FIT (Fecal Immunochemical test) kit that claims 98% sensitivity and 93% positive predictivity (ref).

I bought from them by mail order but now it looks like they sell in some major drug stores and also Amazon.
posted by JoeZydeco at 11:49 AM on January 25, 2022

Fecal immunohistochemical testing is an annual stool screening that tests for microscopic amounts of blood in the stool. It's been shown to be essentially equivalent to colonoscopy in reducing mortality from colon cancer if done annually, but will not detect pre-cancerous polyps the way colonoscopy does. It is definitely not 98% sensitive, it's about 75% sensitive for colon cancers, which is why it's done every year.

Cologuard (fecal DNA testing, which looks for common mutations found in colon cancers and high-grade polyps) is another stool test that is more accurate than FIT testing and only has to be done every 3 years but also detects fewer polyps than colonoscopy. It's about 92% sensitive for cancer but less accurate for high-grade polyps, and also has about a 12% false-positive rate.
posted by The Elusive Architeuthis at 11:57 AM on January 25, 2022 [4 favorites]

Yes. Here's a guide from the Mayo Clinic. If you want to get into the weeds, here's a table comparing various methods, from the US Preventative Services Task Force. As always, check with your medical provider for the best test for you.
posted by Mr.Know-it-some at 12:03 PM on January 25, 2022 [1 favorite]

If you do choose to go with one of the non-colonoscopy kits to monitor, keep in mind that you may encounter false positives. As if only I had a penguin mentions above, these are screening rather than diagnostic. Don't freak out if your test shows positive for something and you're sent for a colonoscopy - it doesn't necessarily mean you have cancer. It just means you need a more thorough, definitive test.
posted by invincible summer at 12:08 PM on January 25, 2022 [1 favorite]

I recently went for my first physical since turning 50, all prepared to have to make an appointment for a colonoscopy, when my doctor suggested Cologuard. They send you a box, you poop in it (they give you this whole kit to make it somewhat easy and clean) and you mail it back to them. In a couple of weeks your doctor gets the result. You're supposed to repeat it every three years and in some cases the results will tell you that you should have a colonoscopy.

I'm in the US and my insurance covered it. YMMV.
posted by bondcliff at 12:08 PM on January 25, 2022

I wouldn't buy any drugstore test for something like this, especially if your insurance will cover Cologuard. Pooping in a box and putting it in the mail is...something, but it's better than a colonoscopy. Note that if you have any high risk factors like a family history of colon cancer, you'll need to get the scope.
posted by praemunire at 12:39 PM on January 25, 2022 [1 favorite]

A friend warned me to be cautious about doing something like cologuard with insurance. The problem is if you get a positive and need additional screening, your insurance will not cover the actual colonoscopy because they already covered the home test. Take that with a grain of salt, because I'm sure it depends on your insurance!
posted by beyond_pink at 1:57 PM on January 25, 2022

I recently went for my first physical since turning 50, all prepared to have to make an appointment for a colonoscopy, when my doctor suggested Cologuard.

Same with me except it was more like I was in an appointment with the GI doc for the colonoscopy pre-screen and I was bitching and complaining about all the prep time, the lack of eating for nearly a day, the hassle of getting a ride home when they couldn't give me an appointment time until the day before and he rolled his eyes and said "Well for people without risk factors there is Cologuard" and it worked out fine for me. Only downside was delivering a box to the post office that you AND the guys at the post office know contains your own poop, but that was minor. I'm not against getting a colonoscopy if it turns out I need one but this was so much less hassle.
posted by jessamyn at 2:04 PM on January 25, 2022

The problem is if you get a positive and need additional screening, your insurance will not cover the actual colonoscopy because they already covered the home test.

This seems...pretty unlikely. What, they're going to skip straight to paying for chemo or surgery you might not even need?
posted by praemunire at 3:16 PM on January 25, 2022 [1 favorite]

Same with me except it was more like I was in an appointment with the GI doc for the colonoscopy pre-screen and I was bitching and complaining about all the prep time, the lack of eating for nearly a day, the hassle of getting a ride home when they couldn't give me an appointment time until the day before and he rolled his eyes and said "Well for people without risk factors there is Cologuard" and it worked out fine for me. [...]I'm not against getting a colonoscopy if it turns out I need one but this was so much less hassle.

Same. No family history or other risk factors aside from my age and I think it's kind of a barbaric thing to do to the entire population just because they turned 50, regardless of lifestyle. I am suspicious of default invasive tests (define as you like) across the population. It seems grifty to me--that's a lot of insurance money circulating blindly--but I refine decisions on tests based on my risk factors, circumstances, other concerns, or just random anxiety.

I think it depends on personal risk tolerance and what you need for peace of mind.
posted by A Terrible Llama at 4:01 PM on January 25, 2022 [1 favorite]

Nthing Cologuard. My doctor prescribed it because she knows I'm a baby about anything medical. It was with the understand that if the results came back anything but normal, I'd have to get the colonoscopy.
posted by Serene Empress Dork at 5:17 PM on January 25, 2022

Hi - I’m an oncologist and not your oncologist. I am strongly biased in favor of colonoscopy as a screening test for anyone who can feasibly undergo one. I work closely with colorectal surgical specialists and they generally agree. The reason is this:

A colonoscopy is a diagnostic procedure, as well as a therapeutic one. If a bad polyp is seen, it can be snared out (treated) and it won’t become a cancer in 5-10 years. Diagnostic because, well, it can diagnose colon and rectal cancer.

Noninvasive tests are diagnostic only, and their sensitivity to detecting polyps is limited. I use Cologuard routinely in patients who cannot safely undergo a colonoscopy - perhaps too frail or they need to be on anti coagulation and the risk of coming off for a screening procedure is high.

Really, I just want everyone to screen. After seven years of taking care of so many patients who didn’t or couldn’t get screened, and now have incurable colon (and breast and cervical) cancers, I have no better reason to tell people to screen beyond that.
posted by honeybee413 at 9:23 PM on January 26, 2022 [5 favorites]

Chiming in here to agree with honeybee. While non-invasive tests do reduce mortality associated with colorectal cancer, they serve to detect (hopefully early) cancer. They do not detect polyps, for the most part.
Non-invasive tests are better than not screening at all, obviously, but as a GI doc I am similarly strongly biased in favor of colonoscopy as a screening tool.
posted by M. at 9:46 AM on January 27, 2022 [1 favorite]

The problem is if you get a positive and need additional screening, your insurance will not cover the actual colonoscopy because they already covered the home test.

This seems...pretty unlikely. What, they're going to skip straight to paying for chemo or surgery you might not even need?

The issue here is that, in the US, insurance companies are required to provide colon cancer screening at no cost. However, if you do a noninvasive screening test and it's positive, the follow up colonoscopy to check out the abnormal result is no longer a screening test, it's a diagnostic test to work up the abnormal screening test, and it's subject to copays and deductibles etc. Colonoscopy is in kind of a weird place in that the diagnostic test is also an acceptable screening test which is why people get confused about it, sort of like if cervical cancer screening could be done by a pap smear or by heading straight to colposcopy under current guidelines.
posted by The Elusive Architeuthis at 11:45 AM on January 28, 2022 [1 favorite]