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At-home test for colon cancer is as reliable as traditional screening: experts

148 points by Kaibeezy 6y ago

Kaibeezy 6y ago
Upgraded, now "as reliable as the traditional screening". Annual and free in most of the UK for a couple of years now. Thank you, NHS.
haspoken 6y ago
http://archive.is/vIt5m http://archive.is/vIt5m
aidenn0 6y ago
Just finished a checkup with my Doctor who told me I'm likely to have a FIT at 45 rather than colonoscopy at 50. They've wanted to lower the screening age for a while, but the resources just aren't there to do colonoscopies on everyone 45+.
- deleted 6y ago
  [deleted]
harveywi 6y ago
They missed an opportunity to call this the "Scatological Health Immunochemical Test"
noir_lord 6y ago
I’ve had cameras both ways without anaesthesia, is that not common in the US? They offered sedation or gas and air though. I went for gas and air as it meant I didn’t need anyone to come pick me up and I could go home straight after. Honestly the prep is the worst part.
- TheCoelacanth 6y ago
  I think sedation is typical. They would do it without if you ask, but are not typically going to suggest that.
- crispyambulance 6y ago
  In colonoscopy, the prep is the worst part if you do it with sedation. The prep is just unpleasant because you spend so much time on the toilet. For myself and many others, it's not really about the pain (supposedly there is little to none), it's just the unsettling thought of that scope so far up one's... I was sedated with Propofol and that seemed to be routine in the facility I went to. It was a white fluid that came in through an IV. I remember saying to the nurse as I saw the propfol going in "that tingles..." and she said "that's normal", but it seemed to me that she said her answer before I finished saying "tingles", then a herringbone pattern visual from my tightly shut eyes, then nothing, and I woke as I was being wheeled out to the recovery area and felt no grogginess at all, seemed that only a couple seconds had elapsed from the time I saw the propfol (it was 20 minutes). Powerful drug.
  - gwbas1c 6y ago
    I had Propofol last Friday. I don't even remember going out. I climbed into the surgical seat, moved my limbs to where they could be tied down, while I joked with the nurses and anesthesiologist. I wonder if I just passed out mid-sentence?
    - derekja 6y ago
      more likely you carried on a conversation you don’t remember. I came out of a procedure and the doctor came out afterward to talk about the results and mentioned things I had absolutely no memory of telling him!
  - noir_lord 6y ago
    I didn't find it unsettling but I got over body modesty issues a long time ago due to ill health, I'm just a machine for carrying a brain around and they are mechanics. The last one the doc doing the colonoscopy was training (under supervision) and kept not making the turn, that was somewhat painful but generally yeah they aren't very painful (for me, ymmv etc).
- quercusa 6y ago
  I've had sedation for previous ones but plan to ask for the gas next time. I always felt dopey for a long time after and worry about long-term effects.
- wincy 6y ago
  I’m the only person I’ve ever met in the US who did a colonoscopy without any sedation. It was a little uncomfortable the same way bad cramps are uncomfortable, but great being able to go on with my day. The nurses were very uncomfortable with the whole thing, the doctor had to come in and assure them it was fine. Since it was preventative I didn’t save any money by forgoing anesthesia (I HATE anesthesia, and my mother had had psychotic episodes after coming out of anesthesia, so I’m cautious). The whole procedure was fast and it was interesting to be awake.
  - noir_lord 6y ago
    They didn't really push one or the other here (UK), they just offered both and explained with one it's 10 minutes in recovery and I'm on my way, with the other I'd need to wait for longer and have someone pick me up and with me. So I went for the simpler option.
    - wincy 6y ago
      I had just happened to read that a high percentage of Europeans do it without sedation, which is where I got the idea. Anesthesia is something I avoid as much as I possibly can. I wish now that I’d pushed more to get the endoscopy I had recently done without being completely knocked out, although the doctor (a different doctor) seemed a lot more resistant to that.
      - noir_lord 6y ago
        Endoscopy without anything but the throat spray was fine, the dry heaving isn’t awesome but unlike the endoscopy not eating the day before is no real challenge.
- mtberatwork 6y ago
  > Honestly the prep is the worst part Not to mention the follow up bill from the out of network anesthesiologist.
  - noir_lord 6y ago
    UK so NHS - bill wasn't a problem.
- atombender 6y ago
  I asked the gastroenterologist at my last procedure. He said some people find it painful when the doctor moves the camera around. My overall impression was that it's more for the doctor's convenience than the patient's; the doctor wants to work fast and efficiently without having to deal with the patient's immediate comfort.
emayljames 6y ago
My uncle has created a disposable, biodegradable version and has been doing a lot of work to get this used and known: https://www.mccormackinnovation.co.uk/ https://www.mccormackinnovation.co.uk/ edit: https://www.mccormackinnovation.co.uk/flushaway-stool-collection/ https://www.mccormackinnovation.co.uk/flushaway-stool-collec...
lucioperca 6y ago
Is there evidence that people benefit from the colonoscopy or FIT at all? Or does overtreatment and risk of the procedure outweigh any benefit?
- est31 6y ago
  > Compared with no endoscopic screening, receipt of a screening colonoscopy was associated with a 67% reduction in the risk of death from any colorectal cancer (adjusted OR (aOR)=0.33, 95% CI 0.21 to 0.52). By cancer location, screening colonoscopy was associated with a 65% reduction in risk of death for right-colon cancers (aOR=0.35, CI 0.18 to 0.65) and a 75% reduction for left-colon/rectal cancers (aOR=0.25, CI 0.12 to 0.53). http://dx.doi.org/10.1136/gutjnl-2016-312712 http://dx.doi.org/10.1136/gutjnl-2016-312712 As a rule of thumb, the earlier it is detected, the better any type of cancer is treatable.
- hannob 6y ago
  My impression is that colonoscopy is less controversial than other forms of screening, even among people who tend to see cancer screening very critical. The USPSTF tends to advise against cancer screenings without good evidence, and they are positive about colonoscopy: https://uspreventiveservicestaskforce.org/uspstf/draft-recommendation/colorectal-cancer-screening3 https://uspreventiveservicestaskforce.org/uspstf/draft-recom...
  - capitainenemo 6y ago
    https://uspreventiveservicestaskforce.org/uspstf/recommendation/colorectal-cancer-screening https://uspreventiveservicestaskforce.org/uspstf/recommendat... A link to the current recommendation (2016) since the other one is still in progress.
- RobertoG 6y ago
  I think that one advantage is that the procedure it's not only for screening but preventive. They use it for, at the same time they are checking for problems, remove polyps, that can be precursors of cancer.
- 6y ago
throwaway0a5e 6y ago
Naming the product "Cologuard" was a great opportunity squandered. I can't wait until the people who spent their formative years sharing shock images on IRC and calling people nasty things on 4chan and don't get offended easily (i.e. the people who graduated high-school after the internet became common but before "real name" social media became common) are old enough to be the ones calling the shots in the workplace. We're already starting to see the effect in low stakes and low formality area, e.g. Wendy's twitter account but it hasn't really taken off yet.
- deleted 6y ago
  [deleted]
- shadowprofile77 6y ago
  The rubrics you describe basically cover a whole spectrum of people who also fit into the millennial category, and in my experience they're among the most easily, absurdly offended and politically correct people in modern society... I have more hope for younger generations than them.
elric 6y ago
"Faecal occult blood" (FOBT) home test kits have been around for years. And they don't require sending a sample back to the lab, you just poke a few holes in a turd with something that looks like a mascara brush, put it in a test tube and wait around for a bit. It's super simple. No lab required. If the result is positive, you talk to your doc and possibly have a colonoscopy scheduled. Not sure why this article talks about sending samples back to a lab. Maybe the 100% at home self test isn't approved in the US or something?
- flotzam 6y ago
  Make sure it's an iFOBT though ("immunochemical"), not the legacy gFOBT type. Preferably with two test fields - Hb and Hb/Hp (hemoglobin and hemoglobin/haptoglobin complex) - for that extra bit of sensitivity: https://europepmc.org/articles/PMC4927976/table/tab3/ https://europepmc.org/articles/PMC4927976/table/tab3/ Just buying a couple of those tests (they're cheap!) instead of going through the gatekeepers makes it practical to repeat them over the course of a few days, increasing the chance to catch intermittent bleeding. Obviously go to a doctor if there's any positive result at all.
- raverbashing 6y ago
  The annoying part for that exam is apparently the pre-exam diet
- joezydeco 6y ago
  This company sells iFOBT tests in the USA. https://www.pblabs.com/products/second-generation-fit-fecal-immunochemical-test-2-pack https://www.pblabs.com/products/second-generation-fit-fecal-...
elric 6y ago
Considering these tests detect blood, and not all polyps (cancerous or otherwise) bleed, there is no way that this is as accurate as a colonoscopy. Maybe if you take into account that more people are willing to use this test than a colonoscpy, it can be as effective because more people get tested. But that's on population level and not on the individual level.
- Kaibeezy 6y ago
  Yes, that's the problem. I was hoping these results for the FIT meant the uninvasive test was approaching the value of the invasive one, but clearly not close enough for my own comfort.
- cstross 6y ago
  I've done both tests. One thing the colonoscopy came with but the occult blood stool test didn't: a warning that there was a 1 in 1000-10,000 risk of an accidental tear in the colon leading to peritonitis, an immediate surgical emergency (and life-threatening if undetected and untreated). So yes, the colonoscopy might pick up some rare non-bleeding cancers and polyps ... but it's also going to lead to unpleasant surgical complications in its own right. (I have no figures for relative risk: but feel it's worth noting.)
  - hef19898 6y ago
    Thing is, even bleeding polyps and cancers don't bleed all the time. Ask me how I know. So, for simple screening purposes I'd say good enough. If there are any other indications a full colonoscopy would be more reliable.
    - cstross 6y ago
      That's how it works in the Scottish NHS. National stool screening program every two years after you turn 50 (you get mailed a sample tube and send it back to the test centre). If it's a positive, you're called in for a colonoscopy. *But* if you show suspicious symptoms outside of the screening program you get a colonoscopy anyway. (Source: am at very high risk of hereditary colon cancer, had a colonoscopy when my GP learned of the family history, then screening thereafter. All clear so far ...)
hirundo 6y ago
My doctor requested that I get a diagnostic colonoscopy. Because I needed one under my insurance plan I had to pay the full cost, over $3k. If I didn't need one it would be a "screening" colonoscopy, and covered in full by the insurance. Under what logic does that make sense, that you get insurance coverage for a procedure but only if you don't really need it? Does it work like that anywhere outside of the U.S.? The colonoscopy was completely clear. Two years later I was having constipation and bloating problems and went to a gastroenterologist. He examined me, asked a bunch of questions, and I asked for his advice. He said he really couldn't tell me anything ... without a colonoscopy. The two year old one didn't tell him enough, he said. Now I'm supposed to drop another $3k, very likely for another clear test result, just to hear what the doctor says I should do about my constipation and bloating? It felt like a scam. Instead of getting advice from a specialist M.D. I was driven to get it from the internet. And dang if it didn't work. I went on a low-residue diet that resolved my digestive problems almost immediately and has had numerous other benefits. My diabetes is in complete remission, I've lost weight, etc. But when I asked the gastroenterologist if diet changes would help, his answer was short and simple: "No." So I'm very happy to see far less expensive alternatives. One less leverage point for the health care system to empty my wallet.
- davycro 6y ago
  The test in the article screens for colon cancer, which is one of many reasons to have a colonoscopy. It sounds like the GI doctors you consulted performed colonoscopies to assess the cause of your digestive symptoms by looking at your GI tract. The test in the article could not replace that.
- perakojotgenije 6y ago
  Americans and their health insurance problems. I live Serbia, to use Trump's words - in a "shithole country" (and I fully admit it is :-( ). I've never had a colonoscopy but I had a gastroscopy two months ago and it was fully covered by our single payer insurance. At the same time a friend of mine needed to have a gastroscopy and a colonoscopy. He decided to go the private route and also chose a full anesthesia. That costed him 30.000 serbian dinars (~255 euros). So it seems to me that you could buy a return plane ticket to Serbia, stay here for a few days, do a colonoscopy here and it would still cost less than what you need to pay there.
shadowprofile77 6y ago
And how would this test avoid false scares caused by hemorrhoids? They also can create blood in human stool.
- troydavis 6y ago
  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5122631/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5122631/ studied false positives for 34k individuals who underwent colonoscopies in Korea between 2013-2015. The gist is that they found a significantly higher false positive rate - probably between 2.4x higher and 4.8x higher - and in absolute terms, a meaningful FP rate (15% without or 25% with other abnormalities): > Among 3946 participants, 704 (17.8%) showed positive FIT results and 1303 (33.0%) had hemorrhoids. Of the 704 participants with positive FIT results, 165 had advanced colorectal neoplasia (ACRN) and 539 had no ACRN (FP results). Of the 1303 participants with hemorrhoids, 291 showed FP results, of whom 81 showed FP results because of hemorrhoids only. Participants with hemorrhoids had a higher rate of FP results than those without hemorrhoids (291/1176, 24.7% vs. 248/2361, 10.5%; p<0.001). Additionally, the participants with hemorrhoids as the only abnormality had a higher rate of FP results than those experiencing no such abnormalities (81/531, 15.3% vs. 38/1173, 3.2%; p<0.001). The discussion section (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5122631/#__sec16title https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5122631/#__sec1...) has more, particularly some conflicting results with past studies. Also, everything is different for a patient than a population. If a patient has reasonable expectations (ie, that a positive result could easily be false, and is nowhere near conclusive), and they would otherwise obtain a colonoscopy rather than putting it off, then by far the bigger concern is false negatives. That is, if you can take a FIT (or two a few months apart) and skip a colonoscopy based on negative results, the false positive rate doesn't matter much - you're replacing something annoying with something not at all annoying. I couldn't find any good studies of false negatives. After reading this stuff, the one thing I wouldn't do is completely replace colonoscopies in favor of FIT.
  - shadowprofile77 6y ago
    Just as I thought: A test that bases its effectiveness on occult fecal blood will obviously stumble around the very common phenomenon of hemorrhoids, and only a colonoscopy can clarify better. On the other hand, if no blood is detected, there still exists the possibility of polyps or tumor growth which have not recently or yet started to release blood, making this test more than a bit unreliable as a measure of something that could be life or death.
Confiks 6y ago
Another interesting alternative: the pill camera. You fast, swallow a pill containing a camera, a bright LED and a battery, a video is transmitted through your body recorded by a sensor outside, and someone qualified can glance if anything is wrong. Pill teardown here [1], images here [2] (without fasting). The upside is quite clear, especially if you are already used to fasting. The downsides are that you can't control the speed of the pill going through your digestive system, and if a polyp is found, you still need a colonoscopy to remove it (and need to fast again). [1] https://www.youtube.com/watch?v=bH6i3bfie_E https://www.youtube.com/watch?v=bH6i3bfie_E [2] https://www.youtube.com/watch?v=5ufESc1bK78 https://www.youtube.com/watch?v=5ufESc1bK78
- azinman2 6y ago
  They don’t show the same things as a colonoscopy (good for diff stuff), can’t take biopsies, and my understanding is that those are actually more expensive.
- jobigoud 6y ago
  Super interesting. I was expecting a kind of microgram camera... this is a monster pill, I have trouble swallowing small ones, I would probably choke on that. Could it work from the other side as a suppository?
  - Confiks 6y ago
    This robot might qualify, but I'm not sure that will put your concerns aside [1]. [1] https://www.youtube.com/watch?v=86MkG4aYDrc https://www.youtube.com/watch?v=86MkG4aYDrc
gilbetron 6y ago
Having "enjoyed" a colonoscopy recently, I looked into this option, but the upside of a colonoscopy is that if they do find polyps, then can usually take care of them right then and there. Plus, they can also look for other things, and generally react to what they find in real time. Unrelated side note: I did this all during the US election week, so that was a fun few days of stress and weirdness!
- BitwiseFool 6y ago
  I heard from a nurse that the more gross, uncomfortable, or invasive a test is, the more accurate and useful it will be.
  - nickff 6y ago
    The common counter-point is that more invasive tests are more likely to find issues, but that's not the same as being useful. A very controversial test is the (highly invasive) pap smear. I don't take a firm view on the subject, but it does seem to be a complicated subject with valid points on both sides. https://en.wikipedia.org/wiki/Pap_test#Effectiveness https://en.wikipedia.org/wiki/Pap_test#Effectiveness
  - darkerside 6y ago
    This makes economic sense. If an invasive test is not useful, it will no longer be performed.
    - biotechiscool 6y ago
      Unless it is highly profitable
      - MartianSquirrel 6y ago
        It's not a problem you face often with a single payer system (or anything similar)
      - coldtea 6y ago
LatteLazy 6y ago
Silly question, won't this push anyone with piles (haemorrhoids) to the doctor? Isn't that vastly more than the 5% they expect?

148 points by Kaibeezy 6y ago

Upgraded, now "as reliable as the traditional screening". Annual and free in most of the UK for a couple of years now. Thank you, NHS.

haspoken 6y ago

http://archive.is/vIt5m http://archive.is/vIt5m

aidenn0 6y ago

Just finished a checkup with my Doctor who told me I'm likely to have a FIT at 45 rather than colonoscopy at 50. They've wanted to lower the screening age for a while, but the resources just aren't there to do colonoscopies on everyone 45+.

deleted 6y ago
[deleted]

harveywi 6y ago

They missed an opportunity to call this the "Scatological Health Immunochemical Test"

noir_lord 6y ago

I’ve had cameras both ways without anaesthesia, is that not common in the US? They offered sedation or gas and air though. I went for gas and air as it meant I didn’t need anyone to come pick me up and I could go home straight after. Honestly the prep is the worst part.

TheCoelacanth 6y ago
I think sedation is typical. They would do it without if you ask, but are not typically going to suggest that.
crispyambulance 6y ago
In colonoscopy, the prep is the worst part if you do it with sedation. The prep is just unpleasant because you spend so much time on the toilet. For myself and many others, it's not really about the pain (supposedly there is little to none), it's just the unsettling thought of that scope so far up one's... I was sedated with Propofol and that seemed to be routine in the facility I went to. It was a white fluid that came in through an IV. I remember saying to the nurse as I saw the propfol going in "that tingles..." and she said "that's normal", but it seemed to me that she said her answer before I finished saying "tingles", then a herringbone pattern visual from my tightly shut eyes, then nothing, and I woke as I was being wheeled out to the recovery area and felt no grogginess at all, seemed that only a couple seconds had elapsed from the time I saw the propfol (it was 20 minutes). Powerful drug.
- gwbas1c 6y ago
  I had Propofol last Friday. I don't even remember going out. I climbed into the surgical seat, moved my limbs to where they could be tied down, while I joked with the nurses and anesthesiologist. I wonder if I just passed out mid-sentence?
  - derekja 6y ago
    more likely you carried on a conversation you don’t remember. I came out of a procedure and the doctor came out afterward to talk about the results and mentioned things I had absolutely no memory of telling him!
- noir_lord 6y ago
  I didn't find it unsettling but I got over body modesty issues a long time ago due to ill health, I'm just a machine for carrying a brain around and they are mechanics. The last one the doc doing the colonoscopy was training (under supervision) and kept not making the turn, that was somewhat painful but generally yeah they aren't very painful (for me, ymmv etc).
quercusa 6y ago
I've had sedation for previous ones but plan to ask for the gas next time. I always felt dopey for a long time after and worry about long-term effects.
wincy 6y ago
I’m the only person I’ve ever met in the US who did a colonoscopy without any sedation. It was a little uncomfortable the same way bad cramps are uncomfortable, but great being able to go on with my day. The nurses were very uncomfortable with the whole thing, the doctor had to come in and assure them it was fine. Since it was preventative I didn’t save any money by forgoing anesthesia (I HATE anesthesia, and my mother had had psychotic episodes after coming out of anesthesia, so I’m cautious). The whole procedure was fast and it was interesting to be awake.
- noir_lord 6y ago
  They didn't really push one or the other here (UK), they just offered both and explained with one it's 10 minutes in recovery and I'm on my way, with the other I'd need to wait for longer and have someone pick me up and with me. So I went for the simpler option.
  - wincy 6y ago
    I had just happened to read that a high percentage of Europeans do it without sedation, which is where I got the idea. Anesthesia is something I avoid as much as I possibly can. I wish now that I’d pushed more to get the endoscopy I had recently done without being completely knocked out, although the doctor (a different doctor) seemed a lot more resistant to that.
    - noir_lord 6y ago
      Endoscopy without anything but the throat spray was fine, the dry heaving isn’t awesome but unlike the endoscopy not eating the day before is no real challenge.
mtberatwork 6y ago
> Honestly the prep is the worst part Not to mention the follow up bill from the out of network anesthesiologist.
- noir_lord 6y ago
  UK so NHS - bill wasn't a problem.
atombender 6y ago
I asked the gastroenterologist at my last procedure. He said some people find it painful when the doctor moves the camera around. My overall impression was that it's more for the doctor's convenience than the patient's; the doctor wants to work fast and efficiently without having to deal with the patient's immediate comfort.

emayljames 6y ago

My uncle has created a disposable, biodegradable version and has been doing a lot of work to get this used and known: https://www.mccormackinnovation.co.uk/ https://www.mccormackinnovation.co.uk/ edit: https://www.mccormackinnovation.co.uk/flushaway-stool-collection/ https://www.mccormackinnovation.co.uk/flushaway-stool-collec...

lucioperca 6y ago

Is there evidence that people benefit from the colonoscopy or FIT at all? Or does overtreatment and risk of the procedure outweigh any benefit?

est31 6y ago
> Compared with no endoscopic screening, receipt of a screening colonoscopy was associated with a 67% reduction in the risk of death from any colorectal cancer (adjusted OR (aOR)=0.33, 95% CI 0.21 to 0.52). By cancer location, screening colonoscopy was associated with a 65% reduction in risk of death for right-colon cancers (aOR=0.35, CI 0.18 to 0.65) and a 75% reduction for left-colon/rectal cancers (aOR=0.25, CI 0.12 to 0.53). http://dx.doi.org/10.1136/gutjnl-2016-312712 http://dx.doi.org/10.1136/gutjnl-2016-312712 As a rule of thumb, the earlier it is detected, the better any type of cancer is treatable.
hannob 6y ago
My impression is that colonoscopy is less controversial than other forms of screening, even among people who tend to see cancer screening very critical. The USPSTF tends to advise against cancer screenings without good evidence, and they are positive about colonoscopy: https://uspreventiveservicestaskforce.org/uspstf/draft-recommendation/colorectal-cancer-screening3 https://uspreventiveservicestaskforce.org/uspstf/draft-recom...
- capitainenemo 6y ago
  https://uspreventiveservicestaskforce.org/uspstf/recommendation/colorectal-cancer-screening https://uspreventiveservicestaskforce.org/uspstf/recommendat... A link to the current recommendation (2016) since the other one is still in progress.
RobertoG 6y ago
I think that one advantage is that the procedure it's not only for screening but preventive. They use it for, at the same time they are checking for problems, remove polyps, that can be precursors of cancer.
6y ago

throwaway0a5e 6y ago

Naming the product "Cologuard" was a great opportunity squandered. I can't wait until the people who spent their formative years sharing shock images on IRC and calling people nasty things on 4chan and don't get offended easily (i.e. the people who graduated high-school after the internet became common but before "real name" social media became common) are old enough to be the ones calling the shots in the workplace. We're already starting to see the effect in low stakes and low formality area, e.g. Wendy's twitter account but it hasn't really taken off yet.

deleted 6y ago
[deleted]
shadowprofile77 6y ago
The rubrics you describe basically cover a whole spectrum of people who also fit into the millennial category, and in my experience they're among the most easily, absurdly offended and politically correct people in modern society... I have more hope for younger generations than them.

elric 6y ago

"Faecal occult blood" (FOBT) home test kits have been around for years. And they don't require sending a sample back to the lab, you just poke a few holes in a turd with something that looks like a mascara brush, put it in a test tube and wait around for a bit. It's super simple. No lab required. If the result is positive, you talk to your doc and possibly have a colonoscopy scheduled. Not sure why this article talks about sending samples back to a lab. Maybe the 100% at home self test isn't approved in the US or something?

flotzam 6y ago
Make sure it's an iFOBT though ("immunochemical"), not the legacy gFOBT type. Preferably with two test fields - Hb and Hb/Hp (hemoglobin and hemoglobin/haptoglobin complex) - for that extra bit of sensitivity: https://europepmc.org/articles/PMC4927976/table/tab3/ https://europepmc.org/articles/PMC4927976/table/tab3/ Just buying a couple of those tests (they're cheap!) instead of going through the gatekeepers makes it practical to repeat them over the course of a few days, increasing the chance to catch intermittent bleeding. Obviously go to a doctor if there's any positive result at all.
raverbashing 6y ago
The annoying part for that exam is apparently the pre-exam diet
joezydeco 6y ago
This company sells iFOBT tests in the USA. https://www.pblabs.com/products/second-generation-fit-fecal-immunochemical-test-2-pack https://www.pblabs.com/products/second-generation-fit-fecal-...

elric 6y ago

Considering these tests detect blood, and not all polyps (cancerous or otherwise) bleed, there is no way that this is as accurate as a colonoscopy. Maybe if you take into account that more people are willing to use this test than a colonoscpy, it can be as effective because more people get tested. But that's on population level and not on the individual level.

Kaibeezy 6y ago
Yes, that's the problem. I was hoping these results for the FIT meant the uninvasive test was approaching the value of the invasive one, but clearly not close enough for my own comfort.
cstross 6y ago
I've done both tests. One thing the colonoscopy came with but the occult blood stool test didn't: a warning that there was a 1 in 1000-10,000 risk of an accidental tear in the colon leading to peritonitis, an immediate surgical emergency (and life-threatening if undetected and untreated). So yes, the colonoscopy might pick up some rare non-bleeding cancers and polyps ... but it's also going to lead to unpleasant surgical complications in its own right. (I have no figures for relative risk: but feel it's worth noting.)
- hef19898 6y ago
  Thing is, even bleeding polyps and cancers don't bleed all the time. Ask me how I know. So, for simple screening purposes I'd say good enough. If there are any other indications a full colonoscopy would be more reliable.
  - cstross 6y ago
    That's how it works in the Scottish NHS. National stool screening program every two years after you turn 50 (you get mailed a sample tube and send it back to the test centre). If it's a positive, you're called in for a colonoscopy. *But* if you show suspicious symptoms outside of the screening program you get a colonoscopy anyway. (Source: am at very high risk of hereditary colon cancer, had a colonoscopy when my GP learned of the family history, then screening thereafter. All clear so far ...)

hirundo 6y ago

My doctor requested that I get a diagnostic colonoscopy. Because I needed one under my insurance plan I had to pay the full cost, over $3k. If I didn't need one it would be a "screening" colonoscopy, and covered in full by the insurance. Under what logic does that make sense, that you get insurance coverage for a procedure but only if you don't really need it? Does it work like that anywhere outside of the U.S.? The colonoscopy was completely clear. Two years later I was having constipation and bloating problems and went to a gastroenterologist. He examined me, asked a bunch of questions, and I asked for his advice. He said he really couldn't tell me anything ... without a colonoscopy. The two year old one didn't tell him enough, he said. Now I'm supposed to drop another $3k, very likely for another clear test result, just to hear what the doctor says I should do about my constipation and bloating? It felt like a scam. Instead of getting advice from a specialist M.D. I was driven to get it from the internet. And dang if it didn't work. I went on a low-residue diet that resolved my digestive problems almost immediately and has had numerous other benefits. My diabetes is in complete remission, I've lost weight, etc. But when I asked the gastroenterologist if diet changes would help, his answer was short and simple: "No." So I'm very happy to see far less expensive alternatives. One less leverage point for the health care system to empty my wallet.

davycro 6y ago
The test in the article screens for colon cancer, which is one of many reasons to have a colonoscopy. It sounds like the GI doctors you consulted performed colonoscopies to assess the cause of your digestive symptoms by looking at your GI tract. The test in the article could not replace that.
perakojotgenije 6y ago
Americans and their health insurance problems. I live Serbia, to use Trump's words - in a "shithole country" (and I fully admit it is :-( ). I've never had a colonoscopy but I had a gastroscopy two months ago and it was fully covered by our single payer insurance. At the same time a friend of mine needed to have a gastroscopy and a colonoscopy. He decided to go the private route and also chose a full anesthesia. That costed him 30.000 serbian dinars (~255 euros). So it seems to me that you could buy a return plane ticket to Serbia, stay here for a few days, do a colonoscopy here and it would still cost less than what you need to pay there.

shadowprofile77 6y ago

And how would this test avoid false scares caused by hemorrhoids? They also can create blood in human stool.

troydavis 6y ago
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5122631/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5122631/ studied false positives for 34k individuals who underwent colonoscopies in Korea between 2013-2015. The gist is that they found a significantly higher false positive rate - probably between 2.4x higher and 4.8x higher - and in absolute terms, a meaningful FP rate (15% without or 25% with other abnormalities): > Among 3946 participants, 704 (17.8%) showed positive FIT results and 1303 (33.0%) had hemorrhoids. Of the 704 participants with positive FIT results, 165 had advanced colorectal neoplasia (ACRN) and 539 had no ACRN (FP results). Of the 1303 participants with hemorrhoids, 291 showed FP results, of whom 81 showed FP results because of hemorrhoids only. Participants with hemorrhoids had a higher rate of FP results than those without hemorrhoids (291/1176, 24.7% vs. 248/2361, 10.5%; p<0.001). Additionally, the participants with hemorrhoids as the only abnormality had a higher rate of FP results than those experiencing no such abnormalities (81/531, 15.3% vs. 38/1173, 3.2%; p<0.001). The discussion section (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5122631/#__sec16title https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5122631/#__sec1...) has more, particularly some conflicting results with past studies. Also, everything is different for a patient than a population. If a patient has reasonable expectations (ie, that a positive result could easily be false, and is nowhere near conclusive), and they would otherwise obtain a colonoscopy rather than putting it off, then by far the bigger concern is false negatives. That is, if you can take a FIT (or two a few months apart) and skip a colonoscopy based on negative results, the false positive rate doesn't matter much - you're replacing something annoying with something not at all annoying. I couldn't find any good studies of false negatives. After reading this stuff, the one thing I wouldn't do is completely replace colonoscopies in favor of FIT.
- shadowprofile77 6y ago
  Just as I thought: A test that bases its effectiveness on occult fecal blood will obviously stumble around the very common phenomenon of hemorrhoids, and only a colonoscopy can clarify better. On the other hand, if no blood is detected, there still exists the possibility of polyps or tumor growth which have not recently or yet started to release blood, making this test more than a bit unreliable as a measure of something that could be life or death.

Confiks 6y ago

Another interesting alternative: the pill camera. You fast, swallow a pill containing a camera, a bright LED and a battery, a video is transmitted through your body recorded by a sensor outside, and someone qualified can glance if anything is wrong. Pill teardown here [1], images here [2] (without fasting). The upside is quite clear, especially if you are already used to fasting. The downsides are that you can't control the speed of the pill going through your digestive system, and if a polyp is found, you still need a colonoscopy to remove it (and need to fast again). [1] https://www.youtube.com/watch?v=bH6i3bfie_E https://www.youtube.com/watch?v=bH6i3bfie_E [2] https://www.youtube.com/watch?v=5ufESc1bK78 https://www.youtube.com/watch?v=5ufESc1bK78

azinman2 6y ago
They don’t show the same things as a colonoscopy (good for diff stuff), can’t take biopsies, and my understanding is that those are actually more expensive.
jobigoud 6y ago
Super interesting. I was expecting a kind of microgram camera... this is a monster pill, I have trouble swallowing small ones, I would probably choke on that. Could it work from the other side as a suppository?
- Confiks 6y ago
  This robot might qualify, but I'm not sure that will put your concerns aside [1]. [1] https://www.youtube.com/watch?v=86MkG4aYDrc https://www.youtube.com/watch?v=86MkG4aYDrc

gilbetron 6y ago

Having "enjoyed" a colonoscopy recently, I looked into this option, but the upside of a colonoscopy is that if they do find polyps, then can usually take care of them right then and there. Plus, they can also look for other things, and generally react to what they find in real time. Unrelated side note: I did this all during the US election week, so that was a fun few days of stress and weirdness!

BitwiseFool 6y ago
I heard from a nurse that the more gross, uncomfortable, or invasive a test is, the more accurate and useful it will be.
- nickff 6y ago
  The common counter-point is that more invasive tests are more likely to find issues, but that's not the same as being useful. A very controversial test is the (highly invasive) pap smear. I don't take a firm view on the subject, but it does seem to be a complicated subject with valid points on both sides. https://en.wikipedia.org/wiki/Pap_test#Effectiveness https://en.wikipedia.org/wiki/Pap_test#Effectiveness
- darkerside 6y ago
  This makes economic sense. If an invasive test is not useful, it will no longer be performed.
  - biotechiscool 6y ago
    Unless it is highly profitable
    - MartianSquirrel 6y ago
      It's not a problem you face often with a single payer system (or anything similar)
    - coldtea 6y ago

LatteLazy 6y ago

Silly question, won't this push anyone with piles (haemorrhoids) to the doctor? Isn't that vastly more than the 5% they expect?