Why are physicians not ordering annual Stool Tests?

[tridacna]

I had my last one in January. Other than a light diet two days before and a clear liquid diet one day before, the main prep was 12 large white pills around 6pm with a lot of water followed by another 12 pills at 10PM with a lot of water. Was the easiest prep I have had.

SUTAB is easy but I’m just not a tablet type. Much prefer PEG. I have no problem drinking large quantities so it works well for me.

We have gastro issues in our family: my sister and 4 cousins with Crohn’s; 2 cousins with colo-rectal cancer-both succumbed to Covid. I have regular colonoscopies.

 

[DandyDon]

Well, I believe you asked why physicians order or not order a test. Well they go to a school for a long time, then they use this knowledge and experience to practice evidence based medicine (most of the time). To take a step further - US preventive services task force employs physicians and statisticians to summarize the evidence and puts it into guidelines (14 page document) so every physician does not have to re-invent the wheel. There is an one page table in the document that summarizes some of the whys and why-nots if the rest of the document is a hard read.

Ok, I certainly appreciate all of that. I know that a significant amount of work and study is required to become a physician or even a nurse practitioner. I do not know anything about the US preventive services task force, but I'll gladly take your word for it. I know that today's recommendations are to start colon screening at age 45. I don't think that they encouraged it until later in life 30 years ago when my brother learned of his colon cancer as he went for tests only when he couldn't ignore the symptoms anymore.

So, do physicians and nurse practitioners routinely encourage patients today to start colon screening at 45, or is the idea only popular with some? I got the idea that they weren't, but maybe they are.

 

[happy-diver]

every two years between 50 and 74" for real?

L@@k at this Mr DandyDon from TX!!!

"The Lucky Country"

Before NA influence!

 

[Mod63]

What is the convention in Europe for colon cancer screening? Is it consistent across the EU?

Not consistent. For Germany, your health insurance sends you a reminder when you turn 50 to go for a colonoscopy and you get a letter every 5 years after that. Depending on the results, the doctor decides on the frequency, usually every 10 years. If you have family that has been affected, colonoscopies start at 40.

 

[Ukmc]

Ok, I certainly appreciate all of that. I know that a significant amount of work and study is required to become a physician or even a nurse practitioner. I do not know anything about the US preventive services task force, but I'll gladly take your word for it. I know that today's recommendations are to start colon screening at age 45. I don't think that they encouraged it until later in life 30 years ago when my brother learned of his colon cancer as he went for tests only when he couldn't ignore the symptoms anymore.

So, do physicians and nurse practitioners routinely encourage patients today to start colon screening at 45, or is the idea only popular with some? I got the idea that they weren't, but maybe they are.

Yes they are supposed to. Primary care providers are very good at staying on top of preventive health guidelines. As far as colon cancer screening, a shift from 50 to 45 as a starting age of screening is very recent. Thus, some may still wait until 50, that is if no family history or symptoms.

 

[DandyDon]

Yes they are supposed to. Primary care providers are very good at staying on top of preventive health guidelines. As far as colon cancer screening, a shift from 50 to 45 as a starting age of screening is very recent. Thus, some may still wait until 50, that is if no family history or symptoms.

Ok, thanks. I guess my understanding was off then. Admittedly I was not in regular contact with any when I turned 50 so I didn't get that message, which is on me as everyone should have annual exams at least. I have been nagging my daughter and SIL to pursue colon screening and I guess my opening question should have been "Doesn't your regular doc tell you to start these?" I'll ask.

 

[RyanT]

@Akimbo, you are correct that colorectal cancers can arise without developing from adenocarcinomas (in polyps). These cancers can also develop from carcinoid tumors, stromal tumors, and lymphoma. I don't think detecting the other types is as difficult as you may think. When someone develops colorectal cancer, the origin (cell type) can be identified. From this, adenomcarinomas are thought to make up the vast majority of colorectal cancers.

Granted, this not helpful in terms of prevention, but it does provide an understanding of the prevalence of different types.

The problem is then what? Watch and wait? Blast some poor soul with chemo? You can't just chop out random bits of colon to send to a pathologist in the hope of finding "the" spot shedding cancer cells.

Sure you can remove random bits of colon. It seems to be generally frowned upon in the medical community though. No seriously though, it's my understanding that chemo is often the first action taken when non-adenocarcinomas are detected.

My greatest respect goes to the incredibly patient scientists and bioengineers working in this field.

Agreed!

 

[Outbound]

Apologies if this has been covered in an earlier post, since I didn't read the entire thread, but does anyone know if the stool tests detect adenomatous cells? I see the ads for Cologuard all the time, and the claim that it detects up to 92% of colon cancers even in the early stages. That's great and all, but I'm not looking to catch colon cancer in the early stages; I'm looking to catch precancerous adenomas (aka polyps). Not all polyps will become cancerous, but virtually all colon cancers begin as polyps. They are very slow growing, so discovering them and removing them during routine colonoscopies means you essentially eliminate the risk of developing colon cancer.

Yeah, the prep isn't the most fun experience. For me, the hunger was the worst. But the actual procedure isn't a big deal, especially if propofol is used.

 

[Lorenzoid]

Apologies if this has been covered in an earlier post, since I didn't read the entire thread, but does anyone know if the stool tests detect adenomatous cells? I see the ads for Cologuard all the time, and the claim that it detects up to 92% of colon cancers even in the early stages. That's great and all, but I'm not looking to catch colon cancer in the early stages; I'm looking to catch precancerous adenomas (aka polyps). Not all polyps will become cancerous, but virtually all colon cancers begin as polyps. They are very slow growing, so discovering them and removing them during routine colonoscopies means you essentially eliminate the risk of developing colon cancer.

See posts #46-50, 60 and 64, for example.

 

[DandyDon]

I guess my opening question should have been "Doesn't your regular doc tell you to start these?" I'll ask.

My daughter ignores many of my emails so I asked yesterday as I was coming around after my angiogram. I think she said they haven't been doing annual exams! I objected briefly but dropped it as I was still pretty drunk, but I'll be working on this now. I was lucky to not screw up in the years that I didn't bother, my brother not so much. Need to fix this.