Why are physicians not ordering annual Stool Tests?

[DandyDon]

You mentioned that before. Where are you getting this?

"Unfortunately, it's also estimated that 40 percent of at-risk persons have never been screened — for many reasons beyond the obvious." https://health.ucsd.edu/news/features/pages/2018-03-09-listicle-consider-your-colon.aspx

just a few hours of hanging out near the bathroom as the "urge" comes quite quickly .

Very, very quickly. Make sure you have a private, dedicated toilet.

The prep, flushing the colon with Trilyte (Polyethylene glycol) back in 12 years ago, was awful. Thankfully they gave me different flushing solutions on the 2nd & 3rd ones (unfortunately I couldn’t find in my medical record what they were).

I think they had me take several laxatives mixed in gatorade.

 

[Dan]

I did the required fasting/diet the day before and then took stool softener (Dulcolax tablets) followed by a laxative (Miralax mixed with apple juice) a few hours later. If you're careful with your diet a few days in advance and eat very light foods, it's really not a big deal - just a few hours of hanging out near the bathroom as the "urge" comes quite quickly .

Yes. I did all that before the final flushing. Those steps are the same for 3 colonoscopies I have done.

 

[Akimbo]

This is interesting:

Dr. Samadder: Yes, for a long time physicians were under the impression that colonoscopy was 100% or nearly 100% protective from colorectal cancer, however, our data clearly shows that though colonoscopy is excellent, it can capture 94% of all colorectal cancer.

If this is accurate across larger samples, then Cologuard is comparable. It seems to me that detecting genetic markers for colorectal cancer has the potential to be more accurate than a visual inspection.

A related side note, the annual digital exam that most men get to check our prostates includes looking for evidence of rectal cancer. Females typically get rectal exams during their routine gynecologic exams.

A friend was diagnosed with prostate cancer had a prostatectomy and was very disappointed to learn that the dreaded gloved finger inspection would continue.

 

[Lorenzoid]

"Unfortunately, it's also estimated that 40 percent of at-risk persons have never been screened — for many reasons beyond the obvious." Five reasons why people don't get screened for colon cancer | UC San Diego Health

Interesting, thanks. I guess I live in a bubble. Guys I know my age consider that first colonoscopy a rite of passage. Discussing the dreaded prep day is part of the ritual. I'm due for my second in 2023.

 

[RyanT]

If this is accurate across larger samples, then Cologuard is comparable. It seems to me that detecting genetic markers for colorectal cancer has the potential to be more accurate than a visual inspection.

In most cases this isn't true. The cancer develops from mutations in the precancerous polyp. The polyp typically shows up long before the cancer does. So cologuard detects cancer that has already started. Colonoscopies will catch it before the cancer starts. In other words, cologuard won't catch the precancerous polyps.

 

[Paul M]

Which test?

Colon cancer testing and prevention

What you need to know about colon cancer, including when and where you should get checked and tips to protect yourself. Get an at-home test

www.ontario.ca

Fecal Immunochemical Test (FIT)
The fecal immunochemical test (FIT) is a safe and painless test that checks your stool (poop) for tiny amounts of blood, which can be caused by colorectal cancer or some pre-cancerous polyps (growths in the colon or rectum that can turn into cancer over time). You can do this test at home and it only takes a few minutes. You do not have to change your diet or stop taking medication to do the test.

 

[Akimbo]

In most cases this isn't true. The cancer develops from mutations in the precancerous polyp. The polyp typically shows up long before the cancer does. So cologuard detects cancer that has already started. Colonoscopies will catch it before the cancer starts.

I'm not sure the data supports this. Very few biopsied polyps are positive for colon cancer (I forget the percentage). I was told that removing all of them is like a dermatologist removing every mole because it might develop cancer. I can't say how valid this analogy is versus one doctor's opinion.

The key issue is colonoscopies are not normally done very often (5-10 years), are comparatively very expensive, and patients largely hate it (prep mostly). As a result, they aren't performed nearly as often or on as many people that statistics say should get them.

Many (most?) countries are moving away routine colonoscopies in favor or annual fecal tests. The logic is that more colon cancer is found, not that it is less expensive, This is largely because so many more people get tested annually than get scoped every 5-10 years.

Of course treating colon cancer is extremely expensive, aside the humanitarian considerations. Medical science, private insurance, and countries basically do the same calculation — get the best return on the money expended. Fortunately this aligns with the "greatest good" objective.

We know that colonoscopies are not 100% effective, virtually nothing is. The argument that a slightly less effective test given far more often will save more lives (and misery).

I had a positive FIT result last year but the the colonoscopy was negative. The false-positive rate on the FIT is understandably much higher than for Cologuard. Hopefully my FIT was a false-positive and the colonoscopy was not a false-negative.

Most doctors will order annual FIT and Cologuard tests if you tell them you aren't doing routine colonoscopies.

 

[DandyDon]

Colon cancer testing and prevention

What you need to know about colon cancer, including when and where you should get checked and tips to protect yourself. Get an at-home test

www.ontario.ca

Fecal Immunochemical Test (FIT)
The fecal immunochemical test (FIT) is a safe and painless test that checks your stool (poop) for tiny amounts of blood, which can be caused by colorectal cancer or some pre-cancerous polyps (growths in the colon or rectum that can turn into cancer over time). You can do this test at home and it only takes a few minutes. You do not have to change your diet or stop taking medication to do the test.

It also says results in five minutes without mailing poop in?

Here's a bargain package for those in the US: 20 tests for $100, share with friends and family. Second Generation FIT® Fecal Immunochemical Test - Kit of 20

 

[RyanT]

@Akimbo, Yes, the polyps grow slowly and even then, most don't develop into cancer. The reason routine colonoscopies are typically done on a ten year time frame is because they just grow that slowly. But, the analogy of a dermatologist removing every mole is not a good one. Most people have LOTS of moles. Removing all the moles (most of which will not develop into cancer) would leave a person very scarred (obviously why a dermatologist wouldn't do it). By comparison, very few people have lots of polyps. So prophylactically, there is little reason not remove them when found.

I don't disagree that lots of people fail to get screened because they don't want to do a colonoscopy. In that case, cologuard is better than nothing. But, a colonoscopy allows you to go ahead and have any polyps removed at that time. It's about as close as you can get in medicine to a guarantee of preventing cancer. A negative cologuard test means 1) low chance that it missed an existing cancer, 2) you have precancerous polyps that haven't become cancer yet, or 3) you don't have any issues at all. A negative colonoscopy almost guarantees you don't have polyps or cancer.

 

[Akimbo]

A negative colonoscopy almost guarantees you don't have polyps or cancer.

Do we know that all colon cancers present in the form of polyps first? I understood that this is an open question. From my limited reading, cancers likely develop first in the colon wall and then polyps usually develop around them, even though most polyps develop with no detectable cancer.

The potential advantage of a genomic test, not necessary Cologuard, is that cancer cells could be identified as soon as cells are shed into the colon.

Another advantage of a less expensive and non-invasive test is 1 in 7 colon cancers occur BEFORE age 40. My neighbor was diagnosed and treated in his early 30s, but is thankfully in his 80s now. A major problem with slow-growing cancers is they are hard to research. Screening should probably start at 20, but will not happen until the cost and "difficulty" comes way down.