The People's Perspective on Medicine

FIT | Can You Detect Colon Cancer Without a Colonoscopy?

Roll of toilet paper on a toilet concept for constipation and bowel movement

Have you ever had a colonoscopy? It might not be the most pleasant screening test ever devised, but it does save lives. Colon cancer is a leading cause of cancer death, and a colonoscopy is a way to detect colon cancer relatively early. A new type of test called FIT can also be helpful.

Gastroenterologists recommend regular colonoscopies to detect colon polyps that could turn into cancer. We highly endorse such testing, but we recognize that many people don’t like the prep. In addition, people without insurance may find the cost daunting. That’s why we were excited to learn that the over-the-counter FIT (fecal immunochemical test) protocol can be surprisingly helpful (Imperiale et al, Annals of Internal Medicine, Feb. 26, 2019).

Prepping for a Colonoscopy:

If you have ever had a colonoscopy, you know the routine. You have to cut back on healthy high-fiber foods a couple of days before the procedure. You eat no seeds, nuts, whole grains or dried fruit. The day before the colonoscopy all you get is clear liquids.

Either the night before the procedure or the morning of exam, you will likely drink about what seems like an impossible amount of a nasty-tasting prep liquid that will clean you out. (Do not stray far from the bathroom!) The rigor of preparing for a colonoscopy is a small price to pay if you are able to detect colon cancer while it is still easy to treat, however.

What About FIT (Fecal Immunochemical Test)?

The over-the-counter FIT procedure detects hidden blood in the stool. It is surprisingly accurate, though not quite as definitive as a colonoscopy. A recent review of 31 studies published in the Annals of Internal Medicine (Feb. 26, 2019) shows that a home stool test to screen for colorectal cancer may be a useful option. In these studies, 120,000 people completed stool tests before their colonoscopies.

The study demonstrated that such fecal immunochemical tests pick up 75 to 80 percent of cancers. Adjusted for higher sensitivity, they may detect as many as 91 percent of cancers, but they then have a higher rate of false positives. Colonoscopies are believed to detect 95 percent of colorectal tumors.

Although it is not perfect, the FIT protocol can help people at average risk. FIT is not appropriate for people with an especially high chance of colon cancer. Anyone who has a positive result on a FIT stool test will need a colonoscopy as a follow-up.

How Does FIT Work?

Colon cancer is not the only cause of blood in the stool. A number of conditions can affect the results of FIT. They include hemorrhoids, anal fissures, hard stools, Crohn’s disease, colitis and proctitis related to radiation treatment for prostate cancer. People who take a lot of NSAID-type pain relievers like aspirin, ibuprofen or naproxen may also get a false positive test result (Stegeman et al, International Journal of Cancer, Nov. 15, 2013). 

The FIT kit is available online without a prescription. If your doctor recommends a fecal immunochemical test, your insurance company may pay for it, though.

There are a couple of procedures. One involves putting a collection paper sling under the toilet seat. It comes with the kit. Your bowel movement is caught in the paper sling. The kit also contains a tube with a screw cap containing a brush or applicator. You take a sample of stool and put the applicator back into the tube and tighten it. You then send the tube to the company in the special pouch that is supplied. They contact you with the results.

Another kind of FIT kit gives you results at home. You unscrew the “wand” that is supplied with the tube. It is used to collect a small amount of stool from toilet paper. This applicator gets screwed back into the tube and is shaken. Three drops of liquid are placed on a plastic “cassette” and the results are read as positive or negative within a few minutes.

If your doctor has been trying to get you to schedule a colonoscopy and you haven’t done so yet, ask whether a FIT test would be appropriate for you. Using such a test to detect  colon cancer early could save your life. 

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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There are so many unanswered questions in the comments you have received here. How about a follow-up article from you, answering these questions? That would provide a huge service to your readers. And thank you for all you do for us!

The feedback is interesting. My issue about the prep for colonoscopy is that it alters the balance in the intestinal track. As a person with autoimmune issues, that is the last thing I want. I have worked hard to improve my intestinal flora and I don’t want to diminish my intestinal health by increasing intestinal permeability, one of the issues causing autoimmunity. That drink you take does more than “clean out” your intestinal track it alters the flora in it. any response would be appreciated.

What about Cologuard? Is it accurate?

Like many folks, I was in no hurry to have a colonoscopy for all the reasons we all know. At 66 years old, I finally decided it was time to find out if I had anything that needed attention. I had my doctor order the Cologuard test kit and after taking it at home, I sent it back and in a few weeks, it came back positive. This convinced me to schedule a colonoscopy.

The prep drink wasn’t bad at all. I put it in the fridge to get cold, so it actually tasted pretty good going down and had a lemon flavor. Best to quaff it down like a cold beer is what I found.

My colonoscopy was not an unpleasant experience at all. It was rather relaxing, actually. I went under so fast, the next thing I knew, I was in recovery. They told me they removed a polyp that was 3cm (almost 1-1/4″). Result of test came back negative for cancer and a follow-up colonoscopy one year later was recommended. I’ll do that this summer and not fear or delay the procedure at all, since it’s a very passive and non-painful experience.

What you don’t know can kill you, so better to know is really the case. Especially since an at home test can be your first course of action.

DiminishingTrust. I wrote a reply but it disappeared above.
Immediately after my colonoscopy I saw an article in the local paper about the trusted/recommended facility I had been to –citing that their equipment was not sterilized . [properly?] My test was normal although Mom and brother have had polyps removed. 10 years later I have been nagged to have another but have not, and it is now about 12 years.

Finally asked to see the doctor as I had questions. Some representative met with me, told me all was safe but could not tell me how sterilized. I asked to purchase a scope which was met with surprise, silence ,and being dismissed as a fool. None of my doctors have ever recommended the tests mentioned here. Why?

In fact just recently I have read how much a simple stool test could measure about health and plan to ask for that. Amazed even a stool test has never been recommended.
This informative article taught me I need to have one of the mentioned tests. But which one, Colonguard or Fit? A comparison of the two would be appreciated.
Thank you

The test for blood finds cancer after it has already begn. A colonscopy can detect polyps before they become cancerous.

I am very leery of colonoscopy. The last one I had resulted in bowel leakage and peritonitis, septic shock, pulmonary embolism, bleeding ulcers, and almost died. So much scar tissue and adhesions to interfere with procedure. At 75 not willing to submit to another. If you proceed with colonscope and If you use C-pap machine, make sure medical people understand not to remove CO2 during recovery period. Good advice from Graesons.

Why doesn’t the article mention Cologuard for those of low or normal risk? Cologuard is covered by most insurers (85% or more) at no cost to the patient. It is more accurate than FIT and safer than colonoscopy. It requires a mailed sample be submitted every 3 yrs instead of yearly FIT or 10 yr colonscopy.

Exact Sciences in Madison WI is the company that distributes Cologuard. They also have are developing tests for liquid biopsies of most common cancers – probably a few years off, but very promising work now with top flight research organizations.

My husband and I each requested the option of using “Cologuard,” Exact Sciences’ DNA-based screening test that detects colon cancer and pre-cancer cells’ mutated DNA which naturally sloughs off with normal cells’ DNA into stool. We’d read up about current alternatives to colonoscopy and had become so enthusiastic about the Exact Sciences molecular detection technology that we would have paid the few-hundred dollars’ cost out of pocket if our insurance had not covered it! (But our insurance did cover it.)

We prefer the Cologuard option because we see a) benefits of the enhanced sensitivity and specificity of this early detection molecular method that doesn’t rely on eyeballing (or missing) a polyp by looking through a scope, b) the ease-of-use convenience of receiving the test kit at our rural home via UPS, collecting our stool samples at our convenience in the privacy of our home bathroom, and sending the sample kit back to the Exact Science Test Lab via UPS, c) the time advantages- so quick and easy compared to the 2 days’ time dedicated to preparing our guts for the test, traveling the notable distance to and from, having and recovering from the procedure, time away from our work d) safety- not to expose ourselves to the risk of potential injury associated with anesthesia and the invasive colonoscopy procedure now that a preferable option is available to us, and e) lower $$ cost to our healthcare system.

Colonoscopy is very expensive. It’s our desire to minimize unnecessary expense when a lower cost option is available, freeing up the dollars and other limited healthcare resources to be applied to other priorities. In both of our cases, our Primary Care physicians were supportive and prescribed the tests for us, and our health insurance covered it.

my dr. refused since I had a tiny polyp a few years ago. Also I still do not understand why they insist on a Colonoscopy for a small bacterial intestinal infection with chronic constipation . I tried several Gastros they would not treat me. it took me over a year to find someone to take me this procedure which is scheduled in the near future. they, also, refused a stool sample test and that I know would reveal yeast, bacteria, etc.

6 years ago, I had my very first . Had to drink that horrible liquid. Towards the end of drinking that nasty liquid, I do mean nasty, I started to get sick to my stomach. Next day, I had my colonoscopy. Dr. said every think was fine. I made up my mind no more of that nasty tasting liquid.

How is this FIT test different from the Cologuard test?

I find this article very confusing. I’m not sure when you’re talking about an over-the-counter test or the type your doctor prescribes and you mail in – you reference that test but then go back to a home test. I’m also not sure what “immunochemical” test is compared with one that detects blood in the stool. I’m assuming that when you refer to a test that is doctor-prescribed and may be covered by insurance, you’re referencing Cologuard, which I have taken twice in lieu of a colonoscopy (which I did once). Cologuard is way way way easier and since I have no risk factors, my doc feels is perfectly appropriate for me. In fact, full disclosure, I was so impressed with Cologuard the first time I used it, I bought a small number of shares in its maker, Exact Sciences. And my insurance has always paid for it (obviously, it saves them a lot of money compared with a colonoscopy). I’m not sure why you didn’t mention its name, but I think most readers would find it hard to describe to their doctor what this colonoscopy alternative is.

The FIT is not a new test. My doctor has had me do these for a few years now, so I don’t understand the “new” part of this article.

Why don’t we trust the research and advice of the american cancer society.. to whom i have donated hundreds of dollars to over the years? The answer, doctor revenue will be dropped beyond significantly!! The ACS recommends a yearly fecal test for guaiac (hidden blood)… IF the test is positive, THEN get a colonoscopy to see what’s up. My OBGYN nagged me yearly… “But your are 50 now… you MUST have your baseline.” baseline for what? Even polyps are only rarely precancerous, and will bleed to let us know they are there,… yet they scare us beyond words into getting an expensive, unnecessary procedure. I actually did submit to a scope, AFTER a positive quaiac (in the right order).. did have a couple polyps removed… negative for CA, and now they want me back every 3 years.

When I actually had a real possible problem, i could not get an appointment for 5 months because the doctors were booked doing all the screening scopes, on healthy, normal 50 and up year olds, and could not fit a real possible patient in for 5 months!!! Waaaay more money in the healthy. By following the advice and suggestions of the amer. ca society would drop their easy money substantially, so i see why they don’t follow their research. ( OH and what ever happened to the offices that were only “cleaning” their equipment between patients, and caused all sorts of expensive medical care and suffering in the people? My sister is still, 5 years later paying off her hospital stay, but try to prove it was contaminated equip… good luck there!! How DO we find out the policy of equipment cleaning at your personal Doc’s office? I tried and could find no EXACT policy. Even the Dr. said “I’m sure we sterilize”… which actually was not a statement of fact, and knowledge. He wasn’t even remotely concerned.. his nurse didn’t actually know… who Knows? Do they or don’t they? )

Yes, DiminshingTrust. Almost immediately after my first colonoscopy an article in the paper reported that the equipment was not sterilized ‘properly’ at the highly trusted/recommended place I had just been to. Test was normal but after 10 years [now about 12] the doctor is nagging me for a repeat. What to do? Mom and brother have both had polyps removed. [not cancerous]
Although I had none I have resisted returning. Finally went in and met with a representative, to learn about, but received no information about, sterilization, just that it was done. This flexible piece of equipment must need special treatment to sterilize. So requested I purchase my own ‘scope’. Told that was not possible, followed by silence and dismissed with attitude that I was for certain a fool.

None of my doctors have ever mentioned ”Colonguard” or ”Fit” as an alternative. Why not I wonder? I have never even heard of these tests.

I had the home test “COLONGUARD” which attaches to the toilet bowl and has other easy to follow instructions, the procedure is very simple, my only complaint was that it was like sitting on a razor blade. My first sample was “too much fecal matter submitted”…OK…I had to do it again, this time everything was fine, and the test came out negative. Looking back, it was much easier than the improved, yet onerous procedure that was years ago. I am due for another test next year…and with other health problems I have at the moment [A-Fib/treatment] and at my age of approaching 78 years…I would rather just relax and golf my life away. I might do just that.

yes I get it.. However I may be wrong, but I think it is just to fill their pockets.
like years ago it seemed like so many were taking out tonsils.
there are other ways to test for SIBO but all the gastro refused!

Colonoscopy is well worth the slight awkwardness of the prep. Removing a polyp, which could develop into cancer and is an outpatient procedure, is far easier than dealing with cancer later on. To minimize risks, be sure that the doctor is well experienced. I have no hesitation in asking a doctor about how many procedures he or she has done; and how many times have there been complications.

You should take a look at the complaints about the company that produces the FIT colon cancer screening test and their business behavior on the Better Business Bureau’s website. Something told me to check out the company first before ordering and wow!!! I am so glad I did. I would really like to do the test, but I cant afford to lose my money like that.

I had a similar test years ago. It was positive for blood. A subsequent colonoscopy showed a large bleeding polyp – precancerous. Many years later I’ve had additional polyps removed but remained cancer free.

I have had five colon/endoscopes. The doctors have removed polps from both my colon and esophagus. It is a shame that everyone won’t do this procedure. Yes, it is a miserable “pre-procedure” but I have to think that cancer would be even worse. While I don’t know of cancer in my family, I don’t want to be the first to start a new “tradition”.

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