Friday, January 23, 2015

Not Thrilled By Getting Colonoscopies? This Test May Be For You.

Deborah Fisher, MD, MHS, Duke University assistant professor and gastro-enterologist, says there is a test better than cologuard, called FIT: fecal immuno-chemical test.

Two and a half months ago I did a post on a new colon cancer screening test called cologuard, e.g.

Therein I observed:

"Many current stool tests look for blood that could suggest a tumor. Cologuard does this too but the key additional benefit is that it detects DNA that could be a sign of cancer or precancerous growths called polyps. People send a stool sample to a lab, where it is tested. If the test is positive, the next step is a diagnostic colonoscopy.....

 The test, approved by the FDA and nicknamed "Cologuard"   is the first to look for cancer-related DNA in stool (something similar to the earlier blood in stool tests) and is expected to  entice millions of people who've avoided colon cancer screening to get this new home test that's noninvasive"

But Duke University professor Deborah Fisher has a different take, in debunking assorted myths to do with all the cancer screening tests, including cologaurd and colonoscopy. See, e.g.

Among the eye-openers I found:

- Colonoscopy is not the "best test". It is the most accurate for finding polyps but "this is not the same as the best" because "there are clear downsides including cost, risk of complications".    Thus, a non-invasive screening test can "greatly reduce the need for colonoscopy" in the same way that a free psa test can reduce the need for prostate biopsies.

- Even before cologuard appeared, the fecal immuno-chemical test (FIT) has been around for decades and in its current form is included in all the U.S. colorectal cancer screening guidelines.

- It has an advantage over cologuard in having only a 5 % false positive rate compared to 13 % for cologuard which means you are less likely to have to undergo an unnecessary colonoscopy.

- It is covered by all major insurance companies.

- It has a huge cost advantage in that it is typically $25 compared to $600 for cologuard.

 As this FIT is done yearly, it is also a more frequent monitor of the possible emergence of polyps - via testing for occult blood. (Polyps are more prone to bleeding under different circumstances.)

Of course, if signs of cancer - such as blood in the stool - are uncovered, then the colonoscopy must be done next. If that is the case, well, I do it and hope for the best!

To learn more about the FIT procedure, you can go here:

Again, the main priority is for Americans to get some kind of screening, given the incidence of colon cancer as one of the primary killers. Both the cologuard and FIT offer alternatives to the invasive colonoscopy but FIT is less costly, and with fewer false positives - something to bear in mind.

1 comment:

GRP said...

The fundamental problem is: People don't know that bowel cancer "screening" can not only detect cancers, but also PREVENT them by removing pre-cancerous growths. That's a lot of upside that you don't get with "screening" for most other cancers.