Historically, the gold standard for diagnosing colorectal cancer has been the colonoscopy. This procedure involves inserting a thin tube equipped with a camera into the rectum, allowing doctors to visually examine the colon for any abnormal growths. However, in the United States, colonoscopies are routinely performed only on individuals who are 45 years or older, those with a family history of colon cancer, or individuals exhibiting suspicious symptoms like rectal bleeding or pencil-thin stools.
The invasive nature and expense of colonoscopies often lead many to postpone these vital screenings, resulting in millions of individuals falling behind on routine cancer screenings. As the incidence of colorectal cancer rises among younger populations, particularly those in their 20s and 30s, the need for accessible screening options has never been more pressing.
A promising alternative is the fecal immunochemical test, commonly known as the FIT. This non-invasive test offers a quick, safe, and effective way to screen for colorectal cancer. To perform a FIT, individuals simply collect a stool sample in a small plastic tube and mail it to a laboratory for analysis. Research indicates that the FIT is highly effective, with one recent study revealing that it can reduce the risk of dying from colon cancer by an impressive 33%.
The FIT operates differently than colonoscopies. Instead of visually identifying irregular growths, the FIT detects the presence of human hemoglobin in stool samples. According to Dr. Theodore R. Levin, a gastroenterologist with Kaiser Permanente, the presence of hemoglobin suggests that blood has leaked into the digestive system. This is significant because cancerous tissues and large benign polyps are more likely to bleed than healthy tissue.
It's important to note that the blood may not always be visible to the naked eye. The FIT was developed specifically to detect these microscopic bleeds, as explained by Dr. Luigi Ricciardiello, a professor of medicine at The University of Texas MD Anderson Cancer Center. A positive FIT result indicates blood in the stool, which could suggest the presence of colorectal cancer. However, abnormal results do not automatically confirm cancer, as other conditions like hemorrhoids or benign polyps can also cause bleeding. If your FIT result is positive, a follow-up colonoscopy is essential for an accurate diagnosis.
The FIT has proven to be highly effective, capable of detecting up to 84% of colorectal cancer cases. Even if the initial test does not yield a positive result, there remains a significant chance (around 75%) of detecting cancer during subsequent tests. Dr. Levin emphasizes that many growths missed in the first test may be identified upon retesting.
However, it is crucial to be aware of the possibility of false negatives, which can occur in up to 10% of cases. This means that some individuals may receive reassurance that they do not have colon cancer, when in reality, they may. Therefore, understanding the limitations of the FIT is crucial for informed decision-making.
Currently, anyone due for colorectal cancer screening can opt for the FIT without a copayment due to the Affordable Care Act. This includes individuals over 45 or those with a family history of colorectal cancer.
For those under 45, eligibility for the FIT requires being considered at risk due to conditions such as inflammatory bowel disease (e.g., Crohn's disease or ulcerative colitis), a personal or family history of colorectal cancer or polyps, or genetic syndromes like familial adenomatous polyposis (FAP) or Lynch syndrome. If you do not qualify based on these criteria, you may still pursue the FIT by paying out of pocket or through direct-to-consumer options.
It's crucial to note that the FIT is designed for asymptomatic individuals. If you experience persistent stomach pain, unintended weight loss, or visible blood in your stool, a colonoscopy should be prioritized over the FIT.
Approximately 70% of age-eligible adults are current with their colorectal cancer screenings. Many individuals avoid colonoscopies due to concerns about sedation, preparation, or a lack of awareness regarding their screening needs. The FIT presents a less invasive, more accessible, and cost-effective alternative that can significantly improve screening rates.
Dr. Levin highlights that regular use of the FIT can greatly increase the chances of detecting cancer early when it is most treatable. This is especially important for younger adults concerned about rising colorectal cancer rates, but who may not exhibit classic symptoms or have a family history that qualifies them for a colonoscopy.
FITs are available through direct-to-consumer companies such as Everywell, which offers kits for $49, or Labcorp, with kits priced at $89. If your test results are positive, it is essential to consult your doctor for further testing. Alternatively, Dr. Ricciardiello suggests discussing the FIT with your physician, who can order a test kit for you, ensuring a streamlined process for any necessary follow-up care.
