Send-away screenings: What to know about colorectal cancer tests

Are you nervous about getting your first colonoscopy? You might have another option.  

Sara Stanford, a PeaceHealth physician assistant who specializes in gastroenterology, shares insights about colon cancer screenings.

Colon cancer often starts as a polyp (small growth in the colon). It can grow without you noticing any symptoms until the cancer is advanced. That’s why early (and regular) screening is important, she says.  

At-home stool tests are an easy, convenient screening tool to consider. That’s only if you’re at average risk for developing colon cancer. And only if you don’t already have symptoms.

Following are two of the most popular types. Both involve collecting a small sample of your stool (poop) at home and sending it in the mail to a lab for testing. The tests look for signs of polyps.

Cologuard

What the test looks for: Genetic (DNA) changes linked to colon cancer and blood in the stool that may be from colon cancer.

Where to get it: If it’s right for you, your PCP can order the test for you.  

How to prepare: It does not require any preparation.

How reliable it is: It finds 92% of cancer and 42% of large polyps.

What it costs: Insurance often covers this test. Copay or coinsurance will vary by your plan.  

How often it’s done: Every three years. If the test finds evidence of polyps, you will need a colonoscopy.  

Fecal immunochemical test (FIT)

What the test looks for: Hidden blood in the stool, which can be a sign of polyps.

Where to get it: You can buy a FIT kit online or from a pharmacy over the counter. “The biggest concern with purchasing this test on your own is making sure you get adequate follow-up with your provider if the result is positive,” says Stanford.

How to prepare: It does not require any preparation.

How reliable it is: It is about 80% accurate at finding evidence of possible colon cancer.

What it costs: About $25. Check with your insurance plan to see if it’s covered. Learn more about test costs.  

How often it’s done: Once a year. If the results are positive (that means it shows you might have a polyp), you will need a colonoscopy.

“Colonoscopies are still the preferred screening method for colon cancer,” says Stanford.

If your screening colonoscopy is normal (i.e., no polyps), stool-based testing might be an option in the future — as long as your risk for colon cancer remains low.

“I tell my patients that at-home stool-based screening tests are good options — as long as they do them.” Any screening is better than nothing, she says.

Home screenings only for those without symptoms 

It’s important to know that all the home stool-based tests are for patients who don’t have symptoms.

If you have any of these symptoms, talk with your provider about next steps:

• Changes in your bowel habits such as diarrhea and constipation that lasts more than a few days.
• Blood in or on your stool.
• Abdominal pain, aches or cramps that don’t go away.  
• Unexplained weight loss.

Colonoscopy for high risk

If you have a parent, sibling or child who had or has colon cancer or a high-risk polyp, your approach to screenings may be different.  

Doctors recommend starting at age 40 or 10 years before the age your family member was when they were diagnosed, whichever comes first. For example, if your sister was 42 when she got colon cancer, you should have a colonoscopy at 32, or before you turn 40.  

Inflammatory bowel disease also increases your risk for colon cancer. A colonoscopy will help you know for sure how healthy your colon is.

Whether your risk for colon cancer is high or low — the most important message is to get screened.