Stool Tests May Require Colonoscopy Follow-Up
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A recent study found that fewer than half of patients who had an abnormal stool-based colon cancer screening test completed a follow-up colonoscopy within six months.
Colon Cancer Screening Tests Vary in Effectiveness and Accuracy
It’s always good to have options when making important decisions. When it comes to testing for colorectal cancer (CRC), you have many choices. There are several types of screenings, from stool tests to colonoscopy. However, some screenings are more thorough and comprehensive than others.
Stool-based screening tests (SBTs) are non-invasive and efficient, but a positive stool test requires a follow-up colonoscopy. A new study published in JAMA Network Open found that 52 percent of patients did not follow through with colon cancer screening recommendations when blood was found in their stool samples.
Study Finds Poor Follow-Through with Positive Stool Test Results
Elizabeth L. Ciemins, PhD, MPH, from the American Medical Group Association in Alexandria, Virginia, led a quality improvement study to analyze whether screening-eligible adults chose to get a follow-up colonoscopy after an abnormal stool test.
Dr. Ceimens and her research team looked at data from 38 healthcare organizations for 20,581 patients aged 50 to 75 years who received abnormal results from a colorectal cancer SBT. They looked at metrics including race, ethnicity, sex and insurance. The team found 47.9 percent had a follow-up colonoscopy within a median follow-up time of 53 days.
The study found follow-up colonoscopy screening rates were highest among White patients, at 49 percent. Rates were lower among Black patients (37.1 percent), Hispanic patients (38.4 percent) and patients with Medicare and Medicaid (49.2 and 39.2 percent, respectively).
“Use of SBTs may increase overall screening rates, but abnormal results must be followed up with a colonoscopy to diagnose CRC — ideally as soon as possible, but definitely within the six months after an abnormal test result,” the research authors wrote.
Advantages of Colonoscopy Over a Stool-Based Test
Stool-based tests offer many advantages in colon cancer screening because patients can perform them at home. SBTs do not require fasting, bowel prep, transportation or sedation, and patients do not need to take time off from work.
However, SBTs, like fecal immunochemical testing (FIT), guaiac-based fecal occult blood test (gFOBT) and multi-target stool DNA (mt-sDNA) tests, detect blood or abnormal chemicals in the stool. They do not identify the source. Patients should follow up with a colonoscopy within six months of a positive SBT. If the stool test is negative, it needs to be repeated in one to three years, depending on the test performed.
Another limitation of SBTs is that they can be inaccurate. One study found that 10 percent of fecal immunochemical tests could not be processed due to patient errors in collecting the specimen.
“We hope to learn more about where the blame lies,” Rasmi Nair, assistant professor in the Peter O’Donnell Jr. School of Public Health at UT Southwestern Medical Center in Dallas, told Healio. “Is it more patient-related? Did the patient not understand the instructions with regards to FIT or was it more system- or provider-related? Although our research is great at identifying the issue, we still are not able to pinpoint the exact problem.”
A visual exam like colonoscopy can detect and even prevent colon cancer because a doctor visually inspects the lining of the colon with a scope and can remove abnormal tissue called precancerous polyps during the exam. A negative colonoscopy often means the patient does not have to repeat the test for another 10 years. Colonoscopy is a smart option for many patients due to its accuracy and less frequent need for repetition compared to other methods.
Tips to Improve Your Colonoscopy Prep and Exam
Are you concerned about getting a colonoscopy? Or perhaps you have recently received an abnormal SBT and you’re wondering if you should schedule a colonoscopy or skip it.
A colonoscopy has never been easier. The new prep solutions are low volume, more palatable and easier to consume. You also only need to take one day off from work. Below are some tips to prepare for a successful colonoscopy.
The day before prep day:
- Eat a big breakfast, a light lunch and a snack dinner.
- Start a low-fiber diet three days before your colonoscopy.
- Start hydrating several days before prep day.
On prep day:
- Chill the prep beverage and drink it through a straw.
- Chase the prep solution with cold water.
- Enjoy all the clear liquids you like, including black coffee, tea, sodas, juices, popsicles, gelatin, hard candy, Italian ice and gummy bears. (Avoid anything with red or blue dye because it may make it more difficult to examine the colon).
- Use baby wipes, Vaseline or diaper rash cream to give you relief.
- Save your favorite TV show to binge-watch on prep day.
Begin Colon Cancer Screening at Age 45 If You Are at Average Risk
Colon cancer is a leading cause of cancer death in the United States, but one-third of Americans are overdue for a colon cancer screening.
The U.S. Preventive Services Task Force recommends that all adults who are at average risk for colon cancer begin screening at age 45. Individuals with a family history of colorectal cancer, colon polyps, inflammatory bowel disease, Lynch syndrome or Familial Adenomatous Polyposis (FAP) should consider starting screening at a younger age due to their increased risk of developing colon cancer.
Talk to your doctor about when you should begin colon cancer screening. If you experience symptoms like blood in the stool, abdominal pain or cramping, nausea or unexplained weight loss, don’t delay in calling your physician. Most colon cancer is treatable when diagnosed at an early stage, so call today to make an appointment if you are due for a screening.