Had a FIT lately?

Nauseated by the thought of a colonoscopy prep? Colorectal cancer screening is not for the weary. Good news! There’s a new method of screening (FIT) that doesn’t require the traditional quality time in the bathroom (or day off work).

Colorectal cancers are the third most common types of cancer, and are also the third leading cause of cancer-related deaths among women. More than 60,000 women are diagnosed with colorectal cancer annually. This is unfortunate because screening helps find precancerous polyps and colorectal cancer at an early stage, when treatment often leads to a cure. Sadly, surveys show that only 52% of women seek screening for colorectal cancers. Why?

The current recommendation for colorectal cancer screening for an average risk woman  begins at 50 years of age. But did you know that there are more ways to be tested than just a colonoscopy? While a colonoscopy is certainly a reasonable screening method, it also comes with its risksthe dreaded prep, and time away from work. On the up-side, if your colonoscopy is normal you likely do not need another screenings for 10 years. The U.S. Preventive Services Task Force (USPSTF) guidelines for colorectal cancer screening include the following tests:

    • Colonoscopy once every 10 years.
    • High-sensitivity fecal occult blood test (FOBT) once a year.
    • Flexible sigmoidoscopy every 5 years with FOBT every 3 years.

The colonoscopy is the most common study undergone. Few clinicians are performing flexible sigmoidoscopy studies any more. Both of these studies involve a bowel preparation to remove stool that is normally within the colon so the physician-guided scope (long, flexible tubing with a camera on the end) can easily see the walls of the colon and any lurking polyps or other worrisome growths. The “prep” for these studies is a type of laxative and requires close proximity to the bathroom. The actual scope is usually performed under sedation (who’d want to remember that anyway?).

Now let’s talk more about the high-sensitivity fecal occult blood test. The FOBT detects very small amounts of blood or blood products in the stool, which is often the first sign of colorectal polyps and cancers. Blood vessels at the surface of larger polyps or cancers are often fragile and easily damaged by passing stool. The damaged blood vessels usually release a small amount of blood into the stool, but only rarely is there enough bleeding to be noticeable with a bowel movement, which is why these tests are helpful. There are currently two types available. One that uses the chemical guaiac to detect blood (the older method requiring some medication and dietary restrictions). The other newer method, a fecal immunochemical test (FIT), uses antibodies to detect blood in the stool. Both of these come as kits – illustrated instructions included – and are available through most primary care providers. At home, you use a stick or brush to obtain a small amount of stool as your convenience. When you have completed the sample collection, you return the test kit to the healthcare provider or a lab, where the stool samples are checked for the presence of blood. The FIT is being offered by more and more providers. It is easier than the guaiac FOBT since there are no drug or dietary restrictions, as well as more accurate because it is less likely to react to bleeding from parts of the upper digestive tract, such as the stomach. And since vitamins and foods do not affect the FIT, sample collection takes less preparation. Some FIT kits may require as few as one stool sample, instead of three, like the old guaiac FOBT. Once a year testing at home without any prep, what’s not to love?

You can reduce the risk of colorectal cancers by making life style changes. If you are age 50 or older, get screened using the evidence-based method of your choice (thanks Meryl Streep for your PSA!). If you are under the age of 50, talk with your healthcare provider about if you are considered high risk for colorectal cancer.

 

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