Annual stool test may be as effective as colonoscopy, study finds

[zinger1457]

But, the cologuard is done annually and the colonoscopy is completed only at 10 year intervals. I suspect the testing frequency brings the two tests results much closer. IOW, are 10 annual tests each having a 75% detection rate better than one test every decade with a 95% detection rate?

The FIT test referenced in this thread is recommended annually, Cologuard is every 3 years. There's also a big difference in price between the two, looks like FIT cost <$30, my recent Cologuard test was $650.

 

[meleana]

Where are the math wizards/MDs? Are we looking at the odds correctly? The cologuard test finds 75% of cancers compared to the colonoscopy at 95%. But, the cologuard is done annually and the colonoscopy is completed only at 10 year intervals. I suspect the testing frequency brings the two tests results much closer. IOW, are 10 annual tests each having a 75% detection rate better than one test every decade with a 95% detection rate?

ETA: I did the math and came up with a detection rate of 98.1% for 10 annual cologuard tests. But I will yield to the math gods. 1-(.25 x .75 to the 9th) Re-reading the article posted by OP they do indicate two annual cologuard tests come close to the colonoscopy detection rate.

"The study found that the FIT test had a sensitivity of a 75 to 80 percent, meaning it identified cancer in 75 to 80 percent of individuals who had the disease, said lead author Dr. Thomas Imperiale, a gastroenterologist at the Indiana University School of Medicine and Regenstrief Institute in Indianapolis. In comparison, colonoscopy had a sensitivity of 95 percent............. (Unlike a colonoscopy, which is recommended once every 10 years, the FIT test is recommended yearly.)..........What's more, comparing the performance of a single FIT test to a one-time application of colonoscopy as a screening method for colorectal cancer is like comparing apples to oranges, Allison told Live Science. That's because colonoscopy is recommended once every 10 years while FIT testing would be recommended every year, which would allow for the discovery of advanced tumors and early treatable cancers each year, he noted."

A colonoscopy is only recommended for Screenings every 10 years. This is key. Once polyps are found, the future tests are considered Diagnostic and they are no longer considered screenings and your doctor will have you come back in 1,3 or 5 years- not 10.

 

[stepford]

Just a math comment here. Comparing the test that finds 75% of cancers with the one that finds 95% and suggesting that the first applied more frequently can work better than the second ONLY WORKS if the first test detects 75% of all cancers randomly. If the first test has some systematic failure to detect a specific 25% subset of all cancers that won't be fixed by repeating the test 10 times or 1000 times.

Be very careful applying statistics with incomplete information.

 

[flintnational]

Just a math comment here. Comparing the test that finds 75% of cancers with the one that finds 95% and suggesting that the first applied more frequently can work better than the second ONLY WORKS if the first test detects 75% of all cancers randomly. If the first test has some systematic failure to detect a specific 25% subset of all cancers that won't be fixed by repeating the test 10 times or 1000 times.

Be very careful applying statistics with incomplete information.

Thanks. The study authors did go on to indicate that 2 annual FIT tests approached the diagnostic accuracy of a single colonoscopy. So, in this case the results appear to be cumulative. But, your point is well taken and that is the reason I wanted the math folks and MDs to chime in. The direction of the thread seemed to be that the FIT test was not as accurate. But, that observation did not include the error in the other direction, that the FIT was used annually.

 

[flintnational]

The FIT test referenced in this thread is recommended annually, Cologuard is every 3 years. There's also a big difference in price between the two, looks like FIT cost <$30, my recent Cologuard test was $650.

Thanks. I missed that they were two different tests.

 

[flintnational]

A colonoscopy is only recommended for Screenings every 10 years. This is key. Once polyps are found, the future tests are considered Diagnostic and they are no longer considered screenings and your doctor will have you come back in 1,3 or 5 years- not 10.

Correct. The comparison I was making was for initial negative screenings only. Once a positive result is found for the FIT and Cologuard I believe both require a colonoscopy for verification. And, I suspect future tests are colonoscopies. Both indicate the test is only valid for low risk patients. A valid positive finding would likely move a patient out of the eligible screening group.

 

[Rianne]

All I can give here is what the honest doctors and my own research have told me. And what my girlfriend said. She went to medical school and worked as researcher for 40 yrs and ran the lab at a hospital in MN.

Yes, polyps can become cancerous but they almost never do. The more you have or if you have a large one, the higher the chances, especially of you are younger. General rule: If it's 1 cm or less it has <1% chance of becoming cancerous in your lifetime.

If they go cancerous/precancerous at a later date can something be done at that point? Yes. That is exactly what that cologuard is for. All that BS about "only for average risk people" "Not for people who have had polyps" is crap. That want the money but they also want doctors to keep charging for colonoscopies. If you stay out in front of these things there is virtually no chance you will die from it or need a colonoscopy bag. They'll get in, do the thing, and get out. Even my own GP, a guy about late 50's or so, said he has had his last colonoscopy and doesn't recommend them.

Something to think of "risk-wise." Yes, a colonoscopy can have a downside but it is pretty small. Maybe 30 yrs ago it was different. If you start at age 50 and get your final one at age 70 (the traditional age when they no longer recommend them) you'd have THREE in your whole life. That doesn't seem like too much to me especially when you could find yourself at 70 with something advanced. OR with cologuard find yourself at 70 needing surgery instead of having obviated it because you had the polyp snipped 6 years ago...?

Now, if you have one done and they find either cancer, pre-cancerous things or just a sea of various polyps you will be getting colonoscopies more often. Or they will be suggesting that. But your risk for cancer or a larger more complicated/dangerous later operation is also higher. So, that's a different risk equation to work

+1 I use Cologuard. Cancer screening gets complicated. Cancer treatment gets complicated. All the study/research %'s are not as simple as siting 95% of cancers are found by X. Or 95% of cancers are cured by Y. I post this link because of personal research, 2nd, 3rd, 4th professional opinions on different cancer detection I've had over the years. An article, a study or post does not come close to the complexity of these claims one reads or a single DR refers.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1182327/

 

[REWahoo]

... get your final one at age 70 (the traditional age when they no longer recommend them)...

Not sure what the traditional age is, but the Mayo Clinic says 75:

People older than age 75 who have been getting regular colon cancer screening since age 50 and who have had consistently negative screenings — no polyps (adenomas) or colon cancer — and are not at an increased risk of colon cancer because of family history may not need to continue getting routine screening.

Still, that's only three if you have no issues. I had my third (and last!!! ) colonoscopy last week, age 72.

 

[razztazz]

Not sure what the traditional age is, but the Mayo Clinic says 75:

Yes. The original post explained that but I edited for brevity. Traditionally it's been 70 for many years by most sources. Past few yrs they've been pimping 75 because... why not put a senior citizen at risk for a few more bucks? I figure they've databased enough numbers to win enough court cases to still make money if a few people over 75 get killed, .

 

[brett]

We are currently visiting friends in Australia.

The health system there sends out a test kit every year to people over 60. They told us that the response rate is in the 25-30 percent range. Gov’t is tying to get that number up.

 

[RetMD21]

Wife, a nurse, does the FIT annually since she meets the low risk criteria. She gets 2 kits for $30 on Amazon. I got a colonoscopy at 50 which found polyps so I have been following the recommendation for more frequent c scopes. Although colonoscopy is better for finding polyps any of the tests are fine for cancer screening. Here is the American Cancer Society guideline: https://www.cancer.org/cancer/colon...on-diagnosis-staging/acs-recommendations.html

 

[aubailey]

If any of you positive results biopsy people have served in Vietnam there is a reward at the end of the rainbow. Go fill out VA paperwork and you will look at $3000+/mo. for the rest of your life. I had one slightly positive core out of 14 taken and I qualified.

 

[BigNick]

We are currently visiting friends in Australia.

The health system there sends out a test kit every year to people over 60. They told us that the response rate is in the 25-30 percent range. Gov’t is tying to get that number up.

Here in France, it's every two years from age 50. You get a letter from the department that administers it, which contains your identification labels, and pick up the kit itself from your doctor and put the stickers on the cover letter and sample tube. Takeup is about 30%. It is, of course, free of charge.

 

[Koolau]

I'm just glad there are some options for preventing/catching early colon cancer. I've known a few who died from it over the years. Reading the materials here, I'm not sure what I'll do when the time comes (2 years to next colonoscopy). I think I'll do what my doc recommends. YMMV

 

[zinger1457]

If any of you positive results biopsy people have served in Vietnam there is a reward at the end of the rainbow. Go fill out VA paperwork and you will look at $3000+/mo. for the rest of your life. I had one slightly positive core out of 14 taken and I qualified.

Maybe colon cancer is treated differently when it comes to collecting full disability benefits but a friend of mine (retired Army, Vietnam veteran) had prostrate cancer and because of the suspected ties to agent orange use in Vietnam he was placed on full disability during the treatment and recovery phase. Don't recall how long that period lasted, maybe 2-3 years, but he was collecting over $3K/month from the full disability benefit. Once his doctor determined the cancer was gone he was moved from full disability to 25% and the $3k/month payment dropped substantially.

 

[NoMoreJob]

This thread is sooooo relevant for me right now. I am having my second colonoscopy a week from Friday. In all honesty I am looking forward to cleaning out all the fecal decay in me and then a day off of work followed by a big juicy hamburger.
Colonoscopies aren’t so bad, it’s all in how you choose to view them.

I agree.

And you don't have polyps (most common risk factor?) until you have them but you don't know that until you have a colonoscopy. I want them removed before they become cancerous and show up on a Cologuard test.

 

[zinger1457]

I agree.

And you don't have polyps (most common risk factor?) until you have them but you don't know that until you have a colonoscopy. I want them removed before they become cancerous and show up on a Cologuard test.

How often are you having a colonoscopy done to guarantee that you will have all polyps removed before they become cancerous? Most insurers will only cover the test once every 10 years, a lot can happen during that time.

 

[Ronstar]

I’m going to ask my dr. if I can take the Cologuard test instead of a colonoscopy. I had my 1st colonoscopy in order to investigate some abdominal issues. No polyps, but revealed a ruptured appendix. Had the appendix removed. Years later, had a 2nd colonoscopy that couldn’t be completed due to sharp bend in my colon. Probably due to the way my abdomen healed after the appendectomy. So my dr suggested a lower GI to investigate where the colonoscopy couldn’t get. That was an experience that I don’t want to repeat.

 

[NoMoreJob]

How often are you having a colonoscopy done to guarantee that you will have all polyps removed before they become cancerous? Most insurers will only cover the test once every 10 years, a lot can happen during that time.

Had first at 51 with no polyps, 10-yr follow-up recommended. No obvious risk factors.
Had one or two hyperplastic polyps at 61, 5-yr follow-up recommended.
Had 3 adenomatous polyps at 66, 3-year follow-up recommended.

All 3 procedures 100% covered, first under employer insurance, second under private (ACA) insurance, third under traditional Medicare/supplement.

In my experience how often the procedure will be covered is based on what has been found previously and, based on that, what is recommended by the doctor.


See following link about types of polyps mentioned above....
https://www.webmd.com/colorectal-cancer/guide/colorectal-polyps-cancer#1[/url

 

[zinger1457]

I’m going to ask my dr. if I can take the Cologuard test instead of a colonoscopy.

Should also check with your insurer, BCBS covers it under 'preventive' but they do require that the PCP submit a preauthorization request because the lab that processes the Cologuard test is not in the network.

 

[COcheesehead]

Had first at 52 with no polyps, 10-yr follow-up recommended. No obvious risk factors.
Had one or two hyperplastic polyps at 62, 5-yr follow-up recommended.
Had 3 adenomatous polyps at 66, 3-year follow-up recommended.

All 3 procedures 100% covered, first under employer insurance, second under private (ACA) insurance, third under traditional Medicare/supplement.

In my experience how often the procedure will be covered is based on what has been found previously and, based on that, what is recommended by the doctor.


See following link about types of polyps mentioned above....
https://www.webmd.com/colorectal-ca...based on family history. Always 100% covered.

 

[frayne]

This thread is sooooo relevant for me right now. I am having my second colonoscopy a week from Friday. In all honesty I am looking forward to cleaning out all the fecal decay in me and then a day off of work followed by a big juicy hamburger.
Colonoscopies aren’t so bad, it’s all in how you choose to view them.

Ditto in spades. No big deal and why take an unnecessary risk. I'm sixty seven and have had three and polyps removed each time and cc does run in the family.

 

[Ronstar]

Should also check with your insurer, BCBS covers it under 'preventive' but they do require that the PCP submit a preauthorization request because the lab that processes the Cologuard test is not in the network.

Thanks, and great advice because I have BCBS.

 

[dtbach]

I'm a believer in Cologuard. So much easier than a full blown colonoscopy.

 

[Montecfo]

My internist said most polyps that occur are found on an initial (versus subsequent) colonoscopies. I think the figure was 80+%.