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Why You’re Not Following Colon Cancer Screening Guidelines

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Considering it’s no secret that colon cancer screenings save lives, it’s shocking to learn that a whopping 76% of deaths from the disease can be traced back to screening failures—on the part of patients.

According to a study of 1,750 people who died from colorectal cancer, researchers at the health organization Kaiser Permanente found that 34% didn’t have any screenings at all, 33% didn’t get tested as often as recommended, and 8% didn’t do the needed follow-up after an abnormal test.

How can it be that people don’t take advantage of tests proved to detect cancer early, when it’s highly curable?

The list of deterrents is long. It takes time and planning and effort to do the prep, line up a friend or loved one to take you and take time off for the procedure. It’s so much easier to put it off indefinitely even though the financial cost of the screening is covered by insurance.

JUST GET SCREENED!

Some health-care centers around the country have started outreach efforts to get and keep patients up-to-date on screenings, both with reminders and colonoscopy alternatives that can be done at home. For instance, Kaiser Permanente patients are sent test kits by mail—and now more than 80% of its patients are up-to-date with screenings, as compared to the national average of 60%. What’s more, the number of deaths from colorectal cancer among its patients has dropped by 50% in the 10 years since this program was started.

But you can’t rely on your doctor or local hospital to nudge you into action. While colonoscopy is still the gold standard (and the only option for people at high-risk), if you don’t have time for it, don’t want to do the prep, or whatever reason you’re putting it off, talk to your doctor about whether you can start with a home test. These tests, which have become more accurate over the years, involve collecting one or more stool samples and sending them off to a lab or doctor’s office. Important: If you test positive, you will need a colonoscopy to investigate, and it won’t be considered a screening test, so you will be charged. If you have a high deductible and will end up paying for this out-of-pocket, you might want to rethink starting with a home test, since preventive colonoscopy screening is covered by insurance.

If you do opt for an at-home test, know that there are differences among the available tests.

Stool DNA. Known by the brand name Cologuard, this test looks for abnormal DNA cells in the sample. Studies show that it is the mostsensitive of the home tests for detecting all stages of colorectal cancer as well as precancerous lesions. Repeat every three years.

High-sensitivity guaiac-based fecal occult blood test (gFOBT) and fecal immunochemical test (FIT). These home tests look for the presence of blood in stool, which can indicate advanced polyps or colorectal cancers. But they have limitations—they don’t pick up early polyps (when they’re most treatable) or the types of polyps that don’t tend to bleed. With the gFOBT test in particular, you have to change your diet for three days leading up to the test because certain foods and supplements can skew results. According to research analyses, FIT tests may be more sensitive than gFOBT with fewer false positives, but there are even differences between brands of FIT tests and not enough study about them to say for certain what brand is best. Repeat every year.

Important: Try to do any home testing in a cool month—heat can affect the samples while in transit to the lab.

FOLLOW UP

Regardless of the type of test you have—at home or a colonoscopy—if results come back abnormal, follow up within eight to 12 weeks. You owe it to your health and to your loved ones to take this and all the important screening steps.

ANOTHER OPTION?

In 2016, the FDA approved a blood test that looks for a marker of colorectal cancer called mSEPT9. Not enough studies have been done to say that it is as accurate as the home tests, and it has a high false-positive rate—about 20% compared to less than 5% for FIT. However, some doctors feel it’s a better-than-nothing option for people refusing all other first-round screening tests and worth discussing with your health-care provider.

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Source: Douglas A. Corley, MD, PhD, gastroenterologist at Kaiser Permanente, San Francisco Medical Center, research scientist at Kaiser Permanente, Northern California, clinical professor of medicine at University of California, San Francisco, and senior author of the study “Modifiable Failures in the Colorectal Cancer Screening Process and Their Association with Risk of Death” published in Gastroenterology. Date: January 2, 2019 Publication: Bottom Line Health
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