At-home check gives different to colonoscopy

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Most Americans who are due for a colon cancer screening will receive a postcard or a call — or prompting during a doctor’s visit — to remind them that it is time to schedule a colonoscopy.

But at big health care systems like Kaiser Permanente or the Veterans Health Administration, the process has changed. Patients who should be screened regularly (ages 45 to 75) and who are of average risk, get a letter telling them about a home test kit arriving by mail.

It is a FIT, which stands for fecal immunochemical test. The small cardboard mailer contains equipment and instructions for taking a stool sample and returning the test to a lab, to detect microscopic amounts of blood. A week or so later, the results show up on an online patient portal.

Five to 6% of patients will have a positive test and need a follow-up colonoscopy. But a great majority are finished with colon cancer screening for the year — no uncomfortable prep, no need to skip work or find someone to drive them home after anesthesia, no colonoscopy.

Last spring, when the pandemic closed many medical facilities and postponed nonemergency procedures, this approach looked even more desirable. “We know that from March to May, colon cancer screenings fell by about 90%,” said Dr. Rachel Issaka, a gastroenterologist.

Colon cancer represents the third-highest cause of cancer deaths, after lung cancer and, tied for second place, breast and prostate cancer. Unlike those, colon cancer can be prevented with early detection.

“If your doctor tells you a colonoscopy is better, that’s not accurate,” said Dr. Alex Krist, chair of the U.S. Preventive Services Task Force, which lowered the recommended age to start screenings to 45. “The data show the tests are equally effective at saving lives.”

A colonoscopy offers one distinct advantage: If the gastroenterologist spots polyps, growths that over time could become cancerous (although most don’t), these can be removed immediately. “You’re preventing cancer, snipping out the things that could lead to cancer,” said Dr. James Goodwin, a geriatrician. After a negative colonoscopy, patients don’t need another one for a decade.

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