Use of aspirin, other NSAIDS, and blood thinners can cause anemia as well if you are bleeding internally over time. We do a lot of colonoscopies at my facility to look for causes of anemia.
Emily, you should demand that your doctor find a reason for the anemia. It might be a bleeding problem but it could be something else entirely.
@ams5796 â Iâm sorry to learn of your illness. But wouldnât it be better to advocate for routine annual FOBT testing starting at a younger age? (rather than colonoscopy) Statistics show that the gFOBT or FIT are only marginally less likely to identify early stage cancer than a colonoscopy â ( see
http://fivethirtyeight.com/features/you-could-skip-your-colonoscopy-if-youre-willing-to-collect-your-poop/ and charts at http://jama.jamanetwork.com/article.aspx?articleid=2529486#ClinicalConsiderations ) â and the FIT test is also inexpensive & no potential of any adverse side effects. So I could see it as very feasible for doctors to advocate - and insurers to pay for, an annual at-home screening that costs less than $30 starting age 35 or 40 ⊠whereas the expense and risk associated with colonoscopy for younger people might be a much harder sell.
I mean â when you mentioned a concern to your doctor at age 48, an FOBT was ordered and the test had a positive result that led to followup. If that FOBT had been part of routine screening when you were age 40⊠perhaps your own outcome would have been different.
Not all colon cancers bleed so a negative FOBT does not mean a person doesnât have colon cancer.
I agree Calmom. Start FOBT at an early age
But my point is that I think it would be tough to get the federal agencies + insurance companies + patients on board for colonoscopy at age 40 â but a lot easier to get everyone on board for a >$30 test done with a home kit. And the statistics show that annual FIT/ FOBT testing is roughly 95% as effective as colonoscopy in terms of preventing cancer deaths.
Your doctor did a FOBT test and then ordered a colonoscopy based on the results. What would have happened if the FOBT had come back negative? Would the doctor have still gone forward with a colonoscopy? Or taken a wait-and-see approach, given you werenâtâ reporting other symptoms?
Iâd note that the in-office FOBT that your doctor did is not the same as the at-home FOBT or FIT. The statistics are pretty clear â overall, if people actually do the annual testing it is potentially as effective as colonoscopy in terms or preventing cancer deaths.
I understand that your situation is horrifying â but I can tell you that the reason I didnât get a colonoscopy at age 50 was that at the time (pre-ACA) I couldnât afford the cost of the testing.
That FOBT that I had in the doctorâs office was completed ten years ago. Those FOBT obtained with a single stool sample in a doctorâs office could miss up to 95% of cancers and adenomas. If the FOBT had come back negative I would not be here now to have this conversation. Luckily my FOBT was positive and a follow up colonoscopy was ordered.
Now, the right way to do an FOBT is with an at home test collecting at least three samples. A person canât have bleeding gums, canât eat certain foods and canât have aspirin NSAIDs, etc seven days prior to the test. I canât imagine the compliance rate is very high. Iâm not sure doctors are using this method in all cases.
But again, the doctorâs office FOBT is NOT the same as the home FIT or gFOBT test that I am talking about. The article you linked to clearly states that:
https://www.cdc.gov/media/pressrel/2010/r100415a.htm
You wrote:
Thatâs the old test - the one they were using 10+ years ago.
The current FIT test doesnât have any of those restrictions:
See https://medlineplus.gov/ency/patientinstructions/000704.htm
No dietary concenr, no advanced prep, no problems with meds. The only caveat is to not do the test if there is possible bleeding from another source â such as if there is a known UTI infection or the woman is having her period.
I donât think that anyone would be using the old-style home test any more.
This is current information provided by the National Cancer Institute:
As with both types of FOBT, the stool sample for the FIT-DNA test is collected by the patient using a kit; the sample is mailed to a laboratory for testing. A computer program analyzes the results of the two tests (blood and DNA biomarkers) and provides a finding of negative or positive. People who have a positive finding with this test are advised to have a colonoscopy.
In one study of people who were at average risk of developing colon cancer and had no symptoms of colon problems (6), this test detected more cancers and adenomas than the FIT test (that is, it was more sensitive). However, the FIT-DNA test also was more likely to identify an abnormality when none was actually present (that is, it had more false-positive results).
The test is done AT HOME (I thought Iâd follow your lead of talking in all caps to make a point). It would be almost impossible to get folks to work with their poop and put a smear on a card and mail it back. It would not work for the masses. And, knowing what I know I would not trust a negative result.
Since it is inexpensive and easy to obtain I would think that people under fifty who want to do this could do so pretty easily. We would not need to Call on Congress to get this done. We are Calling on Congress to get COLONOSCOPIES paid for for people under fifty since colonoscopies are the gold standard for diagnosis of colorectal cancer.
Every disease could be caught if we screened everyone all the time for everything. But we donât give women monthly Pap smears or breast exams, we donât give men monthly screeners for testicular cancer, we donât test everyone monthly for glaucoma. The cost to the system is a lot, so someone has to draw a line somewhere. The line at 50is somewhat arbitrary, but itâs always going to be arbitrary.
Right on, @Pizzagirl
Anyone who looks at the research worldwide will see that although colonoscopies may catch a few more cancers, at-home poop test are actually much more acceptable to people and have a much higher participation rate. There is pretty much no country besides the USA that uses screening colonoscopies as their âgold standard.â
@ams5796 â âFIT-DNAâ is another test entirely â itâs the one that is being heavily promoted with TV advertising these days - (brand name Cologuard) â but it is costlier and more likely to produce false positives. Plus it isnât yet supported by as much research as the FIT.
[QUOTE=""]
We are Calling on Congress to get COLONOSCOPIES paid for for people under fifty since colonoscopies are the gold standard for diagnosis of colorectal cancer.
[/QUOTE]
You would need research support for that assertion. Declaring something to be the âgold standardâ doesnât make it so:
http://jama.jamanetwork.com/article.aspx?articleid=2529486
You certainly are free to advocate for a law requiring insurers to pay for colonoscopies for younger people⊠but your advocacy might be more effective if you actually sorted out what the other tests are and what they entail. For example, the FIT test technically doesnât involve a poop smear on a card⊠just water. See http://www.insuretest.com/patient/how-to-use.php Part of its design is to avoid as much of the icky stuff as possible.
The policy question is always risk/benefit analysis- given that individuals age 40-49 are at lower risk for colon cancer than individuals 50+, but the risk of adverse events during the colonoscopy is probably about the same - you need statistical information of the sort reported in the JAMA article. Right now you are working up against a recent task force finding that (a) recommends routine screening starting age age 50 because older age is the most significant risk factor, and (b) reports no meaningful difference between outcomes in terms of of preventing cancer deaths among several different screening approaches. So you would need statistical data to overcome that finding â something similar to this 2002 study, but with different results: http://www.nejm.org/doi/full/10.1056/NEJM200206063462304#t=article
So all I am suggesting is that based on the evidence, itâs hard to justify routine use of colonoscopy for younger people without other risk factor ⊠but I donât see the downside in the risk/benefit equation for routine use of home stool testing kits, particularly the FIT (which is the least expensive and least complicated test to perform). It may be true that many people will be resistant and wonât do it - but a person who is unwilling to take a sample of their normal stool in the privacy of their own home is unlikely to be all that willing to go through the much more intrusive and inconvenient steps required for colonoscopy.
As someone who works in a colonoscopy center and whose husband was diagnosed with stage 3 colon cancer at age 47, I have a question about this.
At my center, our goal is not to detect cancers. It is to detect precancerous polyps so that they can be removed BEFORE they become cancer! So Iâd like to know if the results from the 40-49 year group referenced in this included findings of precancerous polyps. If they are finding precancerous polyps in this cohort, I think it speaks to the need to have tests which not only detect cancer, but can detect those lesions that would most certainly develop into cancer if left in the colon.
So do these new fecal tests detect these kinds of polyps? I admit I havenât really studied this.
Iâd suggest that rather than ask me, you read the study which I linked to when I quoted. It does include data about polyps and neoplasms â and as you work at a center, you would know better than I how to interpret the terminology, and sort out the which are the pre-cancerous types and which are the types that donât typically become cancerous. Given that the majority of polyps do NOT become cancerous, I am assuming that that you are referring to a specify subtype when you reference something that âwould most certainly develop into cancer.â
I did find this quote from the study:
So thatâs a very different statement than yours â but again, I encourage you to click the link, read the study, and then come back and explain in lay terminology what the data and numbers mean. All i can say for certain is that the rate is low, and apparently about half or less in the 40-49 year old cohort than the 50+ cohort.
The FIT test canât detect a polyp â or more accurately, it canât distinguish between a cancerous or non cancerous growth - it can only test for the presence of blood in the stool. There are some newer test that add DNA evaluation to the mix, but even though thatâs the one you are seeing the t.v. ads for, there is less data available and that is not the one being currently recommended as an acceptable form of screening by the task force. The FIT test has will give accurate positive results about 80-85% of the time, and negative results are accurate about 95% of the time. (In other words, the rate of false positives is somewhat higher than the rate of false negatives.) The newer DNA tests appear to have a higher detection rate, but also a higher false positive rate â and there are downsides to a false positive.
Iâm not trying to argue to maintain status quo. I am saying that among the lower-risk, under 50 group, it would be a good idea to start the inexpensive, non-intrusive FIT test early. That would be inexpensive, easy to implement, and have a very high probability of spotting early signs of cancer â and of course positive results on a FIT test would be followed by a colonoscopy. I think that if the FIT (or FIT-type) tests were made part of routine health screening, over time there would be more compliance because the ick factor of taking a stool sample diminishes after a person has done it a few times. (Itâs icky to change a toddlerâs diaper or to pick up dog poop or clean a catâs litter box, too â but parents and pet owners get over it and do it as often as necessary).
I just think that this is an approach that is more beneficial overall. It is more likely to reach more people, wouldnât drive up insurance rates, and would identify most if not all cancers or bleeding polyps with out forcing large numbers of patients to undergo a an unnecessary and highly intrusive, inconvenient, and expensive medical procedure.
@calmom, I just got online for a little while today. My stepmom of 48 years died suddenly yesterday, so Iâm not going to be reading the study, at least for a while. Thanks anyway.
Iâm sorry about that, Nrdsb4! I hope youâre hanging on, there. 
Is this study the study or a study?
@Nrdsb4 â Iâm sorry about your stepson. The link I posted isnât going anywhere ⊠take your time, you can always come back in a few weeks and read the study. I
@BunsenBurner - I linked to two different studies. One was a recent study comparing efficacy of different types of screening, published in JAMA. The other was a 2002 study published in NEJM, which reported the results of a pilot study of the results of random colonoscopy screening of individuals age 40-49, compared with results of screening of individuals age 50+ (mean age 60)
I am sure that there are mores studies to be found. The NEJM study is just the one that came up first for me with a Google scholar search for âcolon screening age 40â. I just redid the search looking for more recent studies, and came up with this:
The Prevalence Rate and Anatomic Location of Colorectal Adenoma and Cancer Detected by Colonoscopy in Average-Risk Individuals Aged 40â80 Years (2006)
http://www.nature.com/ajg/journal/v101/n2/abs/ajg200654a.html
Thatâs the only other study I found in the first 3 pages of search results that specifically refers to screening in that age range. That appear to be consistent with the other study,
Obviously some people in the 40-49 age range do have colon cancer â but apparently the rate of such cancers is so low as to make routine screening via colonoscopy in appropriate.
Apparently the rate of colon and rectal cancers in younger patients is increasing - see http://onlinelibrary.wiley.com/doi/10.1002/cncr.25432/full (2010 report, reporting cancer cases in individuals under age 40) â but the recommendation of that article is that doctors be more aware when younger patient present with symptoms such as rectal bleeding. See also http://search.proquest.com/openview/03fd7c0bacf7aae76e52d4b1a5f86f42/1?pq-origsite=gscholar
So again, my point is that there doesnât seem to be evidence to support routine colonoscopy screening for patients under age 50, absent other risk factors-- but at the same time I donât see any downside in the simple, at-home FIT test being added to the array of regular screening for younger patients-- itâs cheap, easy, and no possible side effects other than the occasional false-positive result ⊠so whatâs the downside?
Sigh. Iâm going back on the liquid hell for the 2nd time this year.
Colonoscopy scheduled in December. It will not be a very merry Christmas! lol