The sharp decline in cancer screenings due to the suspension of elective medical procedures has prompted doctors to turn to alternatives, and none have seen a greater increase than in-home colon screening tests.
Screening for colorectal cancer has typically meant a trip to an outpatient surgical center for a colonoscopy or for a somewhat less invasive sigmoidoscopy. During the initial months of the pandemic when COVID disrupted medical care, there was an 86% decline in colon cancer screening, according to the Epic Health Research Network.
Decades ago, medical researchers found testing for the presence of blood in stool could be an effective indicator for potential colon cancer. Patients with abnormal fecal immunochemical test (FIT) results are referred for colonoscopies.
Despite the ready availability of FIT and a second type that detects cancer biomarkers, most doctors continued to recommend colonoscopies for all their over 50 year old patients. Many doctors never even discuss other options, so few patients are aware there are alternatives.
“Some patients are definitely surprised that there are options for colon cancer screening other than colonoscopy,” Lisa Ravindra, MD, an assistant professor of medicine at Rush University Medical Center in Chicago, said in an article on the JAMA Network.
Yet the in-home tests are as good at early detection as a colonoscopy, said Dr. Alex Krist, chairman of the U.S. Preventive Services Task Force. “The data show the tests are equally effective at saving lives,” he told The New York Times.
Because of the rising incidence of colon cancer, the Task Force is expected to recommend lowering the age at which screening should begin to 45. Colonoscopies should be done every 10 years, annually for FIT and every 3 years for Cologuard, the biomarker test.
While routine screenings have increased, Michael Sapienza, chief executive officer of the Colorectal Cancer Alliance, said, “I’m still hearing from a lot of people that we’re not seeing a ton of [routine] screening colonoscopies.”
As a result of the COVID-caused delay in diagnostic testing and the consequent delay in treatment, the National Cancer Institute predicts 4,500 more deaths from colorectal cancers over the next decade. A Lancet study estimated a 15.3–16.6% increase.
Speaking to The Times, Dr. Rachel Issaka, a gastroenterologist at the University of Washington and the Fred Hutchinson Cancer Research Center, said colon cancer screenings, of any type, “are considered non-urgent, but they’re not optional.”
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