Last Monday I got my “At-Home Stool Test Kit” in the mail. This test is called “fecal immunochemical tests” (FITs). This test is done at home and detects tiny amounts of blood in your stool, which is a sign of colon cancer. Researchers found that across 19 studies, FITs caught more than three-quarters of colon tumors and were very good at ruling out cancer. On average, studies found that FITs catch about 79% of colon cancers, and their specificity consistently tops 90%. FITs tests accurately gave a negative result to more than 90% of people who did not have colon cancer. Some doctors say that because you use FITs test every year, 10 screenings over 10 years make it just as good as one colonoscopy every 10 years. If you get a positive FITs result, you have blood in your stool at the time of the test. A colon polyp, a pre-cancerous polyp, or cancer can cause a positive stool test. A positive test raises the chance that you have early-stage colorectal cancer. Abnormal FITs tests don’t always mean that you have cancer. About 10% of people screened with FITs will have an abnormal test result and will require additional testing. Conditions that may produce a positive result on a fecal occult blood test include ulcers, hemorrhoids, polyps and benign tumors.
Fecal Occult Blood Test (FOBT) is another at-home test to detect colon cancer. A FOBT test is similar to a FITs test, except the FIT test is newer and doesn’t require a restricted diet before your test. A FITs test may not detect blood from further up the digestive tract (such as the stomach), which means it is more specific to finding blood coming from the lower gastrointestinal tract than the FOBT.
With a FOBT test, you collect a stool sample from each of two or three bowel movements in a clean container. These samples are usually taken on consecutive days, and then use on an applicator stick to apply a smear of stool to a card. After your samples are dry, you return them to a lab, by mail or in person.
Colorectal cancer is the third most common cancer diagnosed in both men and women in the United States. The American Cancer Society’s estimates there are 104,610 new cases of colon cancer and 43,340 new cases of rectal cancer every year. The American Cancer Society expects about 53,200 deaths during 2020. There are now more than 1.5 million survivors of colorectal cancer in the United States. The overall death rate has dropped. The death rate from colorectal cancer among younger than age 55 has increased 1% per year from 2008 and 2017.
According to the American Cancer Society the following are the symptoms for colorectal cancer:
A change in bowel habits, such as diarrhea, constipation, or narrowing of the stool, that lasts for more than a few days
A feeling that you need to have a bowel movement that’s not relieved by having one
Rectal bleeding with bright red blood
Blood in the stool, which might make the stool look dark brown or black
Cramping or abdominal (belly) pain
Having a strong family history of colorectal polyps or cancer increases your risk for colon cancer. This means you should have a serious talk with your doctor about your risk. You should get genetic counseling to review your family medical tree to see how likely it is that you have a family cancer syndrome. If you have diabetes you are at greater risk in developing colorectal cancer.
Based on recent studies you should get a screening starting at age 40 if you are at high risk. You can even talk to your doctor about getting screened even earlier. Whenever a polyp is discovered you should get a colonoscopy every three years. Before scheduling a colonoscopy ask your doctor for their adenoma detection rate (ADR). Choose a doctor with an ADR of at least 20%. Remember, that means that doctor will only find polyps in one in five people.
FITs test screening is fairly easy. You use a brush to get a stool sample. You then mail it into your lab. There is no special diet, no medication to take nor any change in daily habits.
FOBT kits cost between $15 and $32. If you get a positive FOBT test there will be follow up test cost. FITs kits cost between $50 and $100 per person. If you get a positive FITs test there will also be follow up test cost.
Talk with your doctor to decide which test fits your medical needs. The best test is the one you actually get done.
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