A FIT alternative to colonoscopy comes home in the US

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The much-feared colonoscopy is increasingly been replaced in the US by FIT, the faecal immunochemical test, an at-home test that is as reliable as the traditional screening, health experts say, and more agreeable, writes The New York Times.

Most Americans who are due for a colon cancer screening will receive a postcard or a call – or prompting during a doctorʼs visit – to remind them that itʼs time to schedule a colonoscopy. But, reports The New York Times, at big health care systems like Kaiser Permanente or the federal Veterans Health Administration, the process has changed.

Patients who should be screened regularly (age 50 to 75) and who are of average risk, get a letter telling them about a home test kit arriving by mail.

Itʼs a FIT, which stands for faecal 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.

The report says 5% to 6% of patients will have a positive test and need to schedule a follow-up colonoscopy. But the 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 anaesthesia, no colonoscopy.

The report says last March, when the coronavirus pandemic closed many medical facilities and postponed non-emergency procedures, this approach suddenly looked even more desirable. “We know that from March to May, colon cancer screenings fell by about 90%,” said Dr Rachel Issaka, a gastroenterologist at the University of Washington and the Fred Hutchinson Cancer Research Centre. Although testing has resumed, she said, “weʼre still not back to where we were.”

Yet, The New York Times reports, 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. With many older adults trying to avoid hospitals and surgical centres, even as their risk of colon cancer rises with age, an at-home test provides an alternative to colonoscopy – one that is both safer, with a lower risk of complications and COVID-19 exposure, and does as good a job.

“If your doctor tells you a colonoscopy is better, thatʼs not accurate,” said Dr Alex Krist, chair of the US Preventive Services Task Force, an independent expert panel that reviews evidence and issues recommendations. “The data show the tests are equally effective at saving lives.”

The New York Times reports the Task Force is updating its guidelines for colon cancer screening and this year will likely recommend lowering the age at which it should begin, to 45. But the recommendations on the upper end will remain unchanged: Based on strong evidence, adults up to age 75 should be screened regularly.

A colonoscopy offers one distinct advantage: if the gastroenterologist spots polyps, growths that over time could become cancerous (although most donʼt), these can be removed immediately. But the procedureʼs complications increase with age, although they remain low; the most serious, a perforated colon, requires hospitalisation. Cleaning out the bowel on the day before the procedure, in preparation, is disruptive and disagreeable.

Also, the report says, rural residents may find traveling to a facility difficult. The use of anaesthesia means that every patient needs someone to drive or escort them home afterward. The prospect of spending two to four hours in a facility, even one using rigorous safety measures, will cause some older adults to postpone testing because of COVID-19 fears.

The report says the FIT, which is far more widely used in other countries, avoids many of those difficulties. A marked improvement over earlier at-home stool tests, it requires a sample from one day instead of samples from three, and imposes no food or drug restrictions. A positive result still calls for a colonoscopy, but the great majority of patients avoid that outcome.


Full report in The New York Times (Registration or subscription required)




Annual non-invasive test effective for colon cancer screening – US meta-analysis


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