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Are At-Home Colon Cancer Screening Tests a Reliable Option During COVID-19?

An emtpy stool sample collection tube kit with an orange lit on a solid blue background.

 WLADIMIR BULGAR/Getty

Key Takeaways

  • At-home colon cancer screening tests provide a noninvasive and convenient alternative to colonoscopy.
  • Home screening kits for colon cancer have a high accuracy rate, but they are less effective than colonoscopy at finding precancerous polyps, which can become cancerous if left untreated.
  • Home colorectal cancer screening tests might be appropriate for some average-risk individuals, but colonoscopy remains the gold standard for identifying and preventing colon cancer.

When diagnosed in the early stages, colon cancer has a high cure rate. Yet 2 in 5 individuals who meet the screening criteria do not follow through with testing.

At-home screening tests for colon cancer could provide a more convenient and less invasive alternative for some patients, leading to earlier diagnosis and a better prognosis. And at-home tests may be an especially welcome option as COVID-19 stretches on.

Data from the Epic Health Research Network shows that fewer people are getting routine colon, breast, and cervical cancer screenings. The decline started in the spring of 2020—around the time that the COVID-19 pandemic began.

While more recent data indicates that the numbers have slowly started to rise, over one-third of Americans say they have postponed cancer screening tests because of the pandemic.

Angela M. Nicholas, MD, a board-certified family practice physician, is trying to change that. Nicholas lost her husband, John, to colon cancer in 2019. He was 50 years old, and was diagnosed with colon cancer at 45. She said that John believed strongly in screening for all individuals, and now she's advocating for it, too.

“The age at which patients are diagnosed with colon cancer is decreasing," she tells Verywell. "The epidemiological data supports moving the screening age from 50 to 45, and various insurers are starting to recommend screening at 45."

Statistics

  • Since the beginning of the pandemic, more than 18,800 colorectal cancer screenings have been delayed.
  • Delayed screenings could lead to an estimated additional 4,500+ colorectal cancer deaths over the next decade.
  • There was a 90% drop in colonoscopies and biopsies compared to numbers from the previous year.

Why You Might Prefer Home Colorectal Screening Tests

Colonoscopy—which is typically performed in an outpatient setting—has been the mainstay of colon cancer screening. During the procedure, a thin, flexible camera is guided through the rectum and lower intestine, providing visualization of the rectum and colon.

Angela M. Nicholas, MD

The best screening test is the one that you will do.

— Angela M. Nicholas, MD

Having a colonoscopy can be quite an involved process. To prepare for the test, a patient will start drinking a specially-prepared liquid the night before the procedure. The liquid cleanses the bowel, which means a person's sleep is typically interrupted by frequent trips to the bathroom.

When they arrive at the hospital for the procedure, light sedation relaxes the patient and minimizes discomfort. However, the effects can last after the procedure is done; therefore, a support person must drive the patient home.

At-home colon cancer test kits reduce the hassle of preparing for and recovering from a colonoscopy. The kits arrive in the mail and the patient sends them back to the lab for interpretation, which eliminates the need for patients to take a day off from work or arrange for transportation.

Warning Signs of Colon Cancer

There is no replacement for routine colorectal cancer screening. You should talk to your healthcare provider without delay if you notice bright red blood in your stool, any changes in bowel patterns, or persistent abdominal discomfort.

Types of At-Home Colon Cancer Screening Tests

There are two main types of in-home screening tools for colon cancer: the fecal immunochemical test (FIT) and Cologuard, a stool test that analyzes DNA for signs of cancer and pre-cancer.

Who Can Use At-Home Colon Cancer Tests?

According to the American Cancer Society, FIT and Cologuard are options for people who are at average risk for colorectal cancer.

FIT

A fecal immunochemical test checks for blood in the stool, an early sign of colon cancer. The user applies a stool sample to a card and mails it to a lab for analysis. Medicare covers the FIT once a year for individuals aged 50 and older.

Cologuard

Cologuard also checks for blood in the stool as well as DNA changes to colon cells that could signal cancer. The test is available by prescription and covered by most insurance with no out-of-pocket cost.

The test card is sent directly to the patient along with a pre-paid label that can be used to return the test by mail for analysis at a lab facility. The results are typically available within two weeks.

Cologuard is approved by the Food and Drug Administration (FDA) for use once every three years for people over the age of 45. Medicare covers the test for people 50 to 85 years old who do not have colorectal cancer symptoms and do not have an increased risk of colorectal cancer.

What If My At-Home Result Is Abnormal?

An abnormal result on a FIT or Cologuard test requires a follow-up diagnostic colonoscopy. Once a patient has had an abnormal FIT or Cologuard test, they need to have colonoscopies in the future to screen for colon cancer.

How Reliable Are Home Screening Kits?

FIT has a 70% sensitivity to colon cancers, and Cologuard has a 92% sensitivity. In comparison, colonoscopy finds 98% of colorectal cancers, James S. Leavitt, MD, a board-certified gastroenterologist and Chief Clinical Officer for Gastro Health, tells Verywell.

“Cologuard has about a 13% false-positive rate,” says Leavitt, adding that polyps and hemorrhoids can also cause blood in the stool. “If we do 1,000 Cologuard tests, 130 will be falsely positive.”

James S. Leavitt, MD

While it’s wonderful to find colon cancer early, it’s better not to get it at all.

— James S. Leavitt, MD

“Anybody who has a positive Cologuard result will always have a positive result, even if the follow-up colonoscopy is negative,” says Leavitt. “Once that happens, you are no longer an average risk person. You are now a high-risk person.”

Who Should Be Screened for Colon Cancer?

In 2018, the American Cancer Society revised its guidelines for colorectal cancer screening. The organization now recommends that individuals with an average risk of colon cancer begin regular screenings at age 45. You are considered at average risk if you do not have:

  • A personal history of colorectal cancer or certain types of polyps
  • A family history of colorectal cancer
  • A personal history of inflammatory bowel disease (such as ulcerative colitis or Crohn’s disease)
  • A confirmed or suspected hereditary colorectal cancer syndrome, such as familial adenomatous polyposis (FAP) or Lynch syndrome (hereditary non-polyposis colon cancer or HNPCC)
  • A personal history of getting radiation to the abdomen or pelvic area to treat a prior cancer

Why Colonoscopy Remains the Gold Standard

Polyps—clumps of cells that may become cancerous over time—are easy to remove during a colonoscopy. Removal does not cause additional discomfort or recovery time for the patient.

“Most colon cancers start from polyps. They are asymptomatic as they grow,” Leavitt says. “If we find colon cancer before it causes symptoms, we are in a better position to double the cure rate. While it’s wonderful to find colon cancer early, it’s better not to get it at all.”

Another consideration? Stool tests need to be done more frequently because they are less sensitive than colonoscopy at detecting cancer. "The cost of doing a FIT once a year or Cologuard test every three years winds up being similar to doing a colonoscopy every 10 years," Leavitt says.

What This Means For You

Cancer screenings can be done safely, even during COVID-19. If you are 45 or older, speak with your provider about colorectal cancer screenings. Early detection could save your life.

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Article Sources
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