Are you the right FIT for at-home colon cancer screening?

colon cancer screening Wednesday, March 15, 2017

When your health history or age make it wise to get screened for colon cancer, the options are now easier than ever. You may even be able to use a home test option. For guidance on screening for colon cancer, we talked to Dr. David Buchholz, a Premera medical director.

Q: Who needs a colon cancer screening, and why?

A: Colon cancer screening should begin at 50 years of age for most people. But if you have an increased risk of colorectal cancer, your doctor may suggest you begin screening earlier. Family history among primary relatives (parent or sibling) may increase your risk.

Q: What types of colon cancer screenings are available now?

A: There are two major options: a home test done every year, or a colonoscopy recommended every 10 years:

Fecal Immunochemical Test (FIT). This at-home stool test detects small amounts of bleeding. It doesn't require a doctor's procedure or a special diet and laxatives beforehand. You can do it in the privacy of your bathroom. You'll collect a small stool sample and send it by mail to a lab. This test can be an alternative to a colonoscopy, assuming you don't have other risk factors.

Colonoscopy. A doctor does this procedure using a flexible lighted tube to examine the colon and rectum. You'll receive the procedure with sedation in a hospital or office facility. It requires a day off work and someone to go with you and drive you home afterward. The doctor can biopsy and remove polyps, as well as diagnose other conditions or diseases.

Q: How complicated are these tests?

A: FIT is very simple. It's done at home without special preparation. Using a kit, you collect a small amount of stool. It goes in a small tube or envelope that you'll send off to a laboratory by mail. Your doctor will get the test results. A positive test needs a colonoscopy as a follow-up.

Colonoscopy is more complicated. You must drink a cleansing fluid to flush your colon the day before the procedure. Gentle sedation is often used (although some may need anesthesia). Again, you'll need someone to drive you home. You usually get the preliminary results right away, before you go home.

Q: How often should I get screened?

A: Everyone over age 50 should do one type of colon cancer screening.

If you have a colonoscopy that doesn't detect any issues, and you don't have other risk factors, you only need the procedure every 10 years. If the procedure detects a few polyps, your doctor may recommend the next colonoscopy sooner than 10 years. If you do the FIT test and it is normal (no sign of bleeding in the sample), then you repeat it once a year.

Q: So, when can I stop worrying about screening?

A: The reason for screening tests is to detect risky polyps and early colon cancers. Most often, the “positive” screening test leads to removal of a polyp or discovery of an early cancer that is treatable. Routine screens generally are not needed after age 70 or 75 depending on your overall health. But discuss with your doctor about the frequency and type of screening you'll need as you get older.

Q: What happens if I have a positive test?

A: If a colonoscopy is positive, that means a small polyp, large polyp, or cancer was found. Polyps and early cancers can be removed during the same procedure. This happens to about 20 to 30 percent of people during their first screening colonoscopy. Your follow-up after the colonoscopy depends on your doctor's findings. Doctors who do colonoscopies think polyp removal is an extra advantage. The procedure helps get rid of risky problems before they become early cancers.

If a FIT test is positive, you must see a gastroenterologist to have a colonoscopy. Many times, the colonoscopy shows no cancer. Then you can wait 5 to 10 years for another colonoscopy and restart FIT tests for yearly screening. Sometimes the follow-up colonoscopy shows a polyp or an early colon cancer. Then you'll get further treatment advice from your doctors.

Q: Are these tests accurate?

A: Both are accurate screenings for colon cancer. The U.S. Preventive Services Task Force recommends them. This expert group reviews medical research studies and makes recommendations on proven practices.

Q: Are the screenings covered by health insurance or are there any variables?

A: Colon cancer screening remains one of the most important screenings for long-term health. Most health plans cover recommended preventive screenings at little or no cost. Most health plans cover the FIT. Preventive colonoscopies are covered.

Check with your plan for specifics. You may pay more if your colonoscopy is considered diagnostic. This may happen if a colonoscopy is done to evaluate specific symptoms, such as abdominal pain or rectal bleeding, or to investigate a positive FIT result. Your costs may also change if your doctor finds something, like a polyp, during your screening.

Also, anesthesia options vary based on your plan. So talk with your doctor before your colonoscopy to see what's right for you.

Q: Why did Premera recently send some customers FIT kits?

A: In 2016, Premera sent 4,081 FIT kits to customers in Alaska who appeared to be overdue for screening but live in areas that make it difficult to get preventive care. We sent each kit with a postage-prepaid envelope. About 1 in 4 of the FIT kits we sent out were returned and 40 cases were detected with early stages of disease.

We launched a similar program in 2017 for customers in rural Washington. We're invested in working with our customers to make sure they get the preventive care they need.

Q: What are ways to reduce your risk of colon cancers?

A: These activities reduce your risk:

  • Stop smoking if you can, and cut back on your alcohol use.
  • Be physically active and exercise.
  • Lose weight if you are obese.
  • Increase your intake of dietary fiber by eating more fruits, vegetables, and whole grains.

And most important: don't miss your preventive colon cancer screening. Colorectal cancer screening is covered by most medical plans as preventive care. When found and treated early, the survival rate of colorectal cancer can be 90 percent or greater, according to the American Cancer Society.

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