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Study Shows Many Patients Prefer Stool Test to Colonoscopy for Colorectal Cancer Screening


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Three-quarters of surveyed people preferred to do a fecal immunochemical test (FIT) rather than undergo a colonoscopy for their regular colorectal cancer screening, according to a new Cedars-Sinai study published by Makaroff et al in Clinical Gastroenterology and Hepatology.

“One of the big issues is that many people think colorectal cancer screening and colonoscopy are synonymous, and that the only way to get screened for colorectal cancer is through a colonoscopy,” said Christopher V. Almario, MD, MSHPM, an Assistant Professor of Medicine at Cedars-Sinai Medical Center and corresponding author on the study. “In fact, there are many different ways to get tested.”

Understanding that there are more options like the shorter and less-invasive FIT could persuade more people to get lifesaving screenings. This is especially important, since one-third of Americans are not up-to-date on their colorectal cancer screenings, noted Dr. Almario, and also because of the recent lowering of the recommended age for colorectal screening to 45 years (per the U.S. Preventive Services Task Force in 2021).

Survey Results

For the study, Dr. Almario’s team surveyed 1,000 people aged 40 years or older who had not already been screened for colorectal cancer. Participants considered the top two tests recommended by a multisociety task force made up of representatives from the nation’s leading gastroenterology medical societies: yearly FITs, or colonoscopies every 10 years.

When choosing between the two tests, about three-quarters of people preferred the yearly FIT over a colonoscopy every 10 years for their colorectal cancer screening.

“With the FIT test, there’s no change of diet, no anesthesia, and you can do it at home,” Dr. Almario said. “If it’s negative, then you repeat it a year later. If it’s positive, you do need to come in and get a colonoscopy so we can find the cancer if it’s there, as well as remove any precancerous polyps.”

Interestingly, Dr. Almario noted that investigators were unable to predict which screening method participants preferred based on their demographics and clinical characteristics.

“I think this just shows that everyone is different,” Dr. Almario said. “As clinicians, we simply need to ask patients which test they want to do, because the best test is the test that actually gets done.”

Dr. Almario’s team is now testing education and decision-aid materials that may guide patients’ decision-making when choosing which screening method is right for them.

“If we give patients a choice, we may be able to move the needle in trying to improve colorectal cancer screening rates overall, so that more people can get screened, and fewer people develop this preventable cancer,” he said.

Disclosure: For full disclosures of the study authors, visit cghjournal.org.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
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