Well, all I know is that the colonoscopy at 50 probably saved my life, so I am going to continue to encourage people to get the test as their doctor recommends. I know my 45-year-old friend with stage 3 colon cancer would say the same.
The term āprecancerousā polyp might be somewhat misleading ā only about 5% of the āprecancerousā types (adenomas) go on to develop cancer. So very hard to project out probabilities.
https://www.health.harvard.edu/diseases-and-conditions/they-found-colon-polyps-now-what
Iām not questioning anyoneās individual choice, but I think there are good reasons why countries like Canada choose to go the route of sending everyone FIT tests in the mail rather than paying for routine colonoscopies for everyone.
Iād just add that I personally donāt respond well to hyperbole or scare tactics ā if there is a guaranteed way to deter me from doing something, then making exaggerated claims about risks is a sure-fire way to stop me in my tracks. Thatās because I tend to research and fact-check just about everything, and I often tend to make choices based on my perception of how honest & forthright the information-provider has been.
So Iām just saying that if the question is framed as ācolorectal screening of any typeā vs. ārisk of cancerā ā then the argument makes a lot of sense. But when it is framed as ācolonoscopyā vs. ādying of cancerā ā that can backfire. Thatās called a āfear appealā and research has shown that while it influences some people in the intended way, it can backfire badly with many others. (See https://www.psychologytoday.com/us/blog/emotional-nourishment/201809/fear-appeals )
Thereās actually a study from a randomized trial looking at the impact of a āfear appealā vs. āinformed choicesā strategy for colorectal screening, here:
https://www.cairn-int.info/abstract-E_RIPSO_283_0059ācomparative-effectiveness-of-an-informed.htm
Ironically, go to a CRC support site and you will find lots of people, particularly in their 20s, 30s, and 40s who have numerous syptoms, including outright rectal bleeding, and their doctors refuse to order a colonoscopy because they are ātoo young.ā Despite the fact that incidence of CRC in people of that age is growing rapidly.
Youāll find plenty of people in their 30s with very young children and Stage 4 cancer, some of whom had to fight to get a colonoscopy.
I frankly get tired of the constant quotation here of statistics regarding diet, obesity, yadda, yadda, yadda. The cancer forums also have plenty of vegetarians, runners, and mountain biker/hiker/kayaker/you name it enthusiasts.
Stop whistling in the dark. Stop implying that people with cancer bring it on themselves. Please find another subject to āenlightenā people about: the point about FIT tests has been made. Repeatedly.
Oops, I thought I posted this yesterday and, as I went to check this thread today, here it isā¦
Iām intrigued by the FIT test because I had several non (pre?) cancerous polyps removed during my first colonoscopy at 50 and was given a 7 year pass. I had the second one earlier this year and they didnāt find anything so I was given a 10 year pass. I had a tough time with the prep so, on the one hand, I felt happy but, on the other, it seems like a very long time. I was thinking that maybe Iād ask to do a FIT test around year 5 or 6 for peace of mind.
And now, after reading @calmomās post (#1964), maybe I can wait the full 10 years after all.
@collage1 , please donāt make a decision like that based on what some random anonymous person on the internet says-and that includes me. Talk to a doctor you trust, read the literature, etc. What to do is dependent on your specific medical history.
^^Of course. It just feels like 10 years (as recommended by my GI) is a very long time; Iāll check in mid way to see if a FIT test makes sense for me.
The other rich countries that recommend colonoscopy every 10 years as a primary screening also recommend doing FIT every year or two years (i.e. do both). Most rich countries prefer FIT every year or two years as primary screening. The US is unique in suggesting colonoscopy every 10 years or FIT every year.
https://publichealthreviews.biomedcentral.com/articles/10.1186/s40985-018-0080-0/tables/4
Is the ColoGuard test thatās so heavily advertised the same thing as an FIT?
No, Cologuard includes a DNA test ā it has a lower false negative rate than FIT, but a significantly higher false positive rate. Because the Cologuard is typically done only once every 3 years, even with the higher detection rate, it comes out as less effective for detecting signs of cancer than FIT done annually. (Thatās a factor tied to frequency of testingā so if someone did FIT only once every 3 years, the Cologuard would be better.).
Cologuard is significantly more expensive than FIT ā so thatās why you see it advertised but nothing about FIT. There just is no profit* in a FIT test. See https://www.medscape.com/viewarticle/835506 (in 2012, average cost for a FIT test ws $8; colonoscopy was $6345 ā Cologuard was launched in 2014 with a $502 price tag)
*Iām sure the labs that do the testing do make a small profit, but they are relying on volume from all of the low-cost common tests they do ā and the fact that patients typically get all of their routine testing done at the same lab.
The ick factor is also higher with Cologuard ā with Cologuard an entire stool sample is collected and sent off to the lab, whereas the FIT test involves using a brush to collect a tiny sample to send back.
Hereās a good āat a glanceā comparison chart from the CDC:
https://www.cdc.gov/cancer/colorectal/pdf/sfl_inserts_screening.pdf
I donāt mean this post to be construed as anti-Cologuard - itās just that I did look into it and decided to stick with FIT. But Iāve been doing FIT annually going back quite a few years now, so I already have the benefit of the cumulative series of negative tests. (I started with stool testing because I turned 50 many years before ACA came in, and colonoscopy was simply not affordable for me. By the time I did have insurance that would pay for the test, I had all those years of negative FIT or FOBT tests, which again are pretty accurate on cumulative basis).
So just to check you insurance will cover yearly FIT? Or the OOP cost is negligible?
Well, if you have a false positive with a FIT, your insurance will not cover the follow-up colonoscopy. Ask me how I knowā¦
Cologuard is a brand name; it is sometimes referred to generically as FIT-DNA, since it includes both FIT and a DNA test (the latter of which is the difference from plain FIT and the reason it is much more expensive). Reply #1972 above gives a good description.
https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/colorectal-cancer-screening2 has some comparisons between various methods, including FIT every year, FIT-DNA (Cologuard) every three years, and colonoscopy every ten years. There is a table at the bottom with a summary.
Insurance & Medicare cover annual FIT under preventive benefits. Back in the day before ACA mandated full coverage of preventive benefits, it was subject to my insurance deductible, and I donāt remember what it cost ā but it was pretty low.
A follow-up colonoscopy after a positive FIT test is covered as a diagnostic service rather than preventive. So it is covered by insurance, but subject to the insurance deductible. That would have been a concern for me after ACA came in & I had a high deductible plan. ā no longer an issue as I am now on Medicare.
I donāt think that insurance or Medicare would cover the screening done at greater than recommended frequency. That is, if someone got a colonoscopy and was told to come back in 10 years ā and decides to get a FIT test in year #5 ā not sure whether that would be covered. But the FIT is so cheap that it wouldnāt be a major problem. On the other hand ā if someone was getting FIT yearly, with negative results, but nonetheless decided they wanted a screening colonoscopy instead ā they might have to wait out +1 year after the most recent FIT or +3 years after a negative Cologuard test before the insurance would pay for a screening colonoscopy.
Just had my second one (first was 5 years ago; since my dad died of colon cancer in his 80s my doctor said I should go every 5 instead of every 10, which I donāt believe is necessary but whatever).
SuPrep was FOUL. Almost threw it all up. He said to mix it with lemonade; didnāt help. He gave me the usual restrictions (nothing red or purple; you can have jello or chicken broth). So I had green jello. And he said it made it hard to see. Shouldnāt he have known this??? If you specifically exclude 2 colors, arenāt you saying every other color is A-OK? Not looking forward to doing this again, ever. Me and my colon are moving to Europe.
Most rich countries in Europe recommend more frequent stool blood tests (but colonoscopy if blood is found) as primary screening. Germany and Austria recommend both colonoscopy and stool blood tests in years between scheduled colonoscopy.
If you have information or expertise that leads you to believe your doctor doesnāt know what he is talking about, why do you continue to follow his advice?
There are other methods you can avail yourself of if you donāt want to go the colonoscopy route. At the end of the day, this is your decision to make.
Getting my 3rd one on Wednesday; I am taking miralax and dulcolax to clearing out, which worked just fine 5 years ago, and no salt overload, so easier on the stomach kidneys.
My three colonoscopies were every three years apart. I am thankful for the technology to detect colon cancer early. This next time, I can wait five years. Iāll follow the schedule my doctor recommends.
@Nrdsb4 ā because Iām not a doctor and I assume my information is not as good as his. He is very cautious. I figure itās a minor annoyance and as long as my insurance pays for it, I might as well have the screening done. There are other methods; to my knowledge, a colonoscopy provides the most complete information. What other methods do you know of that provide more information?