By Permanente Medical Staff
You’re probably familiar with colonoscopy, a procedure used to examine the colon to help prevent cancer, and the unpleasant preparation that’s required: a specific diet to be followed beginning a few days before, bowel prep (using a laxative to completely cleanse your colon), and fasting the day of the procedure.
Suffice it to say, it’s not a procedure most people look forward to. But what if there was an easier way to screen for colorectal cancer?
Enter the fecal immunochemical test (FIT), also called the immunochemical fecal occult blood test, which is a noninvasive way to check for colon cancer.
“FIT doesn’t require a trip to the doctor’s office or an alteration to your daily life in any way,” says Dana Sloane, MD, chief of gastroenterology in Baltimore for Mid-Atlantic Permanente Medical Group (MAPMG). With FIT, you collect a fecal sample in the privacy of your own home. You seal the tube with the sample in an envelope, and then put it in the mail. The sample is then checked at the lab for signs of cancer. If signs of blood from the colon are detected, then you need to follow up with a colonoscopy to check for polyps that could be cancerous.
“Colonoscopies are considered polyp detection tests,” explains Dr. Sloane. “But most polyps are not precancerous and don’t require surveillance or treatment.” For that reason, she says, FIT tests can be a viable first option to screen for colon cancer for most average-risk patients.
Colorectal cancer is the third leading cause of cancer-related deaths in the United States, so whichever option you choose, it’s important to be screened. Kaiser Permanente recommends African-American patients begin regular colorectal cancer screening at age 45, and at age 50 for others with average risk.
Those who are at higher risk of colorectal cancer should be screened earlier, Dr. Sloane notes. Risk factors include family history of colon cancer or precancerous colon polyps in a first-degree relative (parent, sibling, or child), and a personal history of inflammatory bowel disease. Other factors, including race and ethnic background (African-Americans and Jews of Eastern European descent have the highest risk), a personal history of other types of cancer, having type 2 diabetes, and smoking or being overweight or obese, may also increase your risk of colon polyps and colorectal cancer. If you’re unsure of your risk, talk with your doctor to determine when you should start regular screening.
The Right FIT?
While there are now a variety of tests that can be used to screen for colon cancer, including virtual colonoscopy (CT colonography), Dr. Sloane says she and her colleagues are increasingly recommending the FIT test for many patients, rather than a colonoscopy.
She’s found that patients often dread colonoscopy prep, and as a result, many put off their colon cancer screening.
Because FIT testing can be done at home and is non-invasive, it doesn’t carry the risks of bleeding, bowel tears, and/or infection that come with colonoscopy. Nor do patients need to be sedated, as is usually the case with colonoscopy, so you don’t need to miss a day of work or worry about getting a ride to and from the doctor’s office.
If you opt for FIT, your doctor can provide an instructional video that explains how to obtain a sample, a process that is easy and clean, which many people don’t expect, Dr. Sloane says.
One important difference between the two procedures: Colonoscopies should be done every 10 years if the last ended in a negative result, and FIT tests should be done annually.
Dr. Sloane says the hardest part of the FIT test is remembering to do it each year. When advising her patients, she reminds them that screening is crucial for catching cancer early. “I ask my patients, you wouldn’t skip your mammogram or diabetes screening tests and leave your health in limbo, right? It’s the same with colorectal cancer screening,” she says.
Your best strategy for remembering when to undergo your next colorectal cancer screening is to “pick a program and stick with it,” says Dr. Sloane. “If you’ve had a negative colonoscopy, you don’t need a FIT test within at least five years of that colonoscopy. Whatever test you choose, always choose to protect your health by getting screened.”
At MAPMG, we make it easy and mail a FIT kit to patients yearly when they are due. Patients receive a kit and instructions in the mail with a stamped return envelope – it’s not even necessary to leave home to be screened. And, a reminder is sent to the patient if the kit isn’t returned timely. Patients can also check when they are due for colorectal cancer screening through the Kaiser Permanente online member portal, kp.org, and can request a kit be mailed to them through that portal.
Before making a choice, talk to your doctor to figure out the best option for you. For more information, visit the website of the American Cancer Society. Learn more about colonoscopy by visiting MAPMG’s Staying Healthy pages.