Home stool test might replace first-line colonoscopy

Carlotta Jarach

A new article published in Annals of Internal Medicine states that average-risk patients can safely choose for an annual home stool test instead of a screening colonoscopy.

In many countries, such as United Kingdom, Canada, and Italy, colonoscopy is typically performed for average-risk individuals with no symptoms only if a fecal immunochemical test (FIT), which is a test that checks for hidden blood in the stool, is positive; in the United States colonoscopy is otherwise considered the gold standard and it is often performed in asymptomatic adults 50 and older without strict limits.

The researchers from Indiana University School of Medicine and the Regenstrief Institute reviewed 31 studies which included both FIT and colonoscopy results for each study participant, with a total of 120,255 participants. Approximately a third of the participants with positive FIT results in these 31 studies were found to have an advanced precancerous polyp or actual colon cancer; FIT findings where compared to screening colonoscopy, resulted in having high detection rates for colorectal cancer.

“Our analysis finds that FIT is a good ‘pre-screening’ test for average risk, asymptomatic adults, saving them hassle and the U.S. healthcare system costs” said Thomas Imperiale, MD, the lead author of the study “If annual FIT results remain negative, FIT buys you time until colonoscopy may be required, and it could be the case that a colonoscopy for screening may never be necessary or required”. Imperiale said the research shows a similar approach could be safely adopted only if there is a system to ensure annual testing: “the power of FIT is in its repeat application and in many cases, repeatedly negative results” he said.

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