A stool test kit and a colonoscopy are two of the screening tests for colorectal cancer that the U.S. Preventive Services Task Force recommends, and colorectal cancer is cancer of the colon or rectum. With a kit, you collect stool at home and send it to your doctor's office or a lab. In a colonoscopy, a provider looks along the inside of your whole colon through a thin, lighted tube with a camera. In general, if you choose a stool-based test, you will need to get tested more often, and if you choose a test that looks inside your colon and rectum, less often.
Why a kit arrived at forty-five when nothing is wrong
Forty-five is the age the recommendation begins: the risk of colorectal cancer goes up as you get older, and that is why screening is recommended for everyone aged 45 to 75. Nothing has to be wrong first. A screening test looks for a disease in a person who has no symptoms, and when someone does have symptoms, other tests, called diagnostic tests, are used to find the cause. Colorectal cancer may not cause symptoms at first, so feeling well is the situation the kit is meant for.
Colorectal cancer almost always develops from polyps, abnormal growths in the colon or rectum. Screening tests can find polyps so they can be removed before they turn into cancer, and they can find colorectal cancer early, when treatment works best.
Between 76 and 85, the decision to be screened is made individually, and your doctor may recommend that you continue, depending on things like your overall health and your preferences.
Some people need to start before 45, or be screened more often than other people. You may need to if you have:
- inflammatory bowel disease, such as Crohn's disease or ulcerative colitis
- a personal or family history of colorectal cancer or colorectal polyps
- a genetic syndrome such as familial adenomatous polyposis, or hereditary non-polyposis colorectal cancer, also called Lynch syndrome
Other risk factors that may mean screening at a younger age or more often include having overweight or obesity, a personal or family history of ovarian cancer, smoking tobacco products and alcohol misuse. If any of these applies to you, talk to your own doctor about which test is right for you and how often to get tested. If you have no doctor of your own to ask, start by finding a primary care provider (see Weight care is not a checkup, so the screenings are still yours to book).
What the kit and a colonoscopy each find, and how often you repeat them
The kit checks a stool sample for blood or other signs of cancer you can't see, and in a colonoscopy a provider looks at the rectum and the entire colon and can find and remove most polyps and some cancers during the test. Which kit you have decides how often you repeat it. For a fecal immunochemical test, or FIT, you will most likely collect samples from one bowel movement; for a guaiac test, or gFOBT, samples from three separate bowel movements; and for a stool DNA test, an entire bowel movement in a special container, which is checked for altered DNA as well as blood. Instructions may vary slightly with the maker of the kit, so follow the ones inside it.
| Stool test kit | Colonoscopy | |
|---|---|---|
| Where it happens | At home; you send the samples to a lab or your doctor's office | Often the outpatient department of a hospital or medical center, for about 30 to 60 minutes |
| Preparation | None for a FIT or stool DNA kit; a guaiac kit may mean avoiding certain foods and medicines for several days | A bowel prep to empty the colon beforehand, and a sedative during it; at least one day for bowel prep and recovery |
| Risk | No risk to the colon | Serious risks are rare, and can include tears in the colon or rectum wall, bleeding, and a reaction to the sedative |
| How sensitive | Can show a false positive and cannot detect precancerous changes; a FIT or guaiac kit may miss some signs of polyps or cancer, and a stool DNA kit may miss some cancers | The most sensitive colon cancer screening test, and it looks at the entire colon |
| How often | Every year for a FIT or guaiac kit; every 3 years for a stool DNA kit | Every 10 years if you do not have an increased risk of colorectal cancer |
The ten-year interval for a colonoscopy applies if no polyps were found in previous tests. Depending on the size and number of polyps, your provider may recommend more frequent colonoscopies. A flexible sigmoidoscopy and a CT colonography are also among the recommended tests. A flexible sigmoidoscopy looks at the rectum and the lower third of the colon and is repeated every 5 years, or every 10 years if you also do a FIT kit every year. A CT colonography is an X-ray scan of the whole colon, repeated every 5 years.
What an abnormal kit result signs you up for
After a positive or abnormal kit result, you need a colonoscopy to complete the screening, and the same goes for a positive or abnormal flexible sigmoidoscopy or CT colonography. With a normal result, you repeat the kit on its own schedule.
An abnormal result doesn't necessarily mean you have cancer. The kit can show blood in the stool when there isn't any, and blood in the stool can come from a health condition that isn't cancer, such as hemorrhoids. Your provider will probably order more tests, such as the colonoscopy, to help make a diagnosis.
Before the colonoscopy, you empty your colon with a bowel prep, following your provider's instructions. Bowel prep can be inconvenient and uncomfortable, and if the colon is not cleaned out, the provider may not get a complete picture of it. During the procedure, you are given a sedative to help you relax and keep you from feeling pain; you may be awake but probably won't remember anything. If you have polyps, your provider may remove them or take tissue samples, which may be sent to a lab for testing. Most polyps aren't cancer, and removing them can keep them from becoming cancer later on. The sedative may make you drowsy for several hours, so arrange for someone to take you home.
Tell the provider doing the colonoscopy about everything you take, including any weight medicine. You may need to stop certain medicines before the test, and you stop none unless you are told to. For a weekly weight medicine, tell whoever prescribes it about the test as well, so the decision is made with them (see Tell the anesthesia team about your weekly weight medicine).
What screening will cost you
What you pay for screening depends on your plan. Under the Affordable Care Act, health insurance plans must cover screening for colorectal cancer, and depending on your plan, you may be able to get screened at no cost to you. All Marketplace plans and many other plans must cover it for adults aged 45 to 75 without charging a copayment or coinsurance, even if you haven't met your yearly deductible. Generally, that holds when an in-network provider does the test; coverage may vary, and a zero cost is not certain in every case.
Call your insurance company before you book anything, and ask whether the kit is covered, whether a colonoscopy after an abnormal kit result is covered as screening, and which providers near you are in network.
With Medicare, Part B covers a follow-up colonoscopy as a screening test after a positive result from a Medicare-covered stool test. The test is covered in full if your provider accepts assignment, meaning they agree to accept the payment amount Medicare approves for it, though other costs may apply. If the provider finds and removes a polyp or other tissue during the colonoscopy, you pay 15% of the Medicare-approved amount for the provider's services, and in a hospital outpatient setting or ambulatory surgical center you also pay the facility a 15% coinsurance. The Part B deductible doesn't apply. With questions about your own Medicare coverage, call 1-800-MEDICARE (1-800-633-4227), the number listed for Medicare coverage questions.
Without insurance, you may still be able to get free or low-cost colorectal cancer screening. Search HRSA's Find a Health Center tool by city, state or zip code, then call that clinic and ask about colorectal cancer screening.
Symptoms to see a doctor about instead of screening
With a symptom that could come from colorectal cancer, see your doctor about it, because when a person has symptoms, diagnostic tests are used to find out the cause, and screening is for people without them. Some of the tests used for screening may also be used as diagnostic tests, to help your provider make a diagnosis when you have symptoms. If colorectal cancer does cause symptoms, they could include:
- a change in bowel habits that lasts more than a few days, such as diarrhea, constipation, feeling that the bowel does not empty completely, or stool that is narrower or a different shape than usual
- blood, either bright red or very dark, in the stool
- frequent gas pains, bloating, fullness or cramps
- weight loss for no known reason
- fatigue
With symptoms that could be caused by colorectal cancer, you may need a physical exam and other tests to find out if you have cancer.
When blood in the stool needs care right away
If you notice blood or a change in the color of your stool, or you feel dizzy or lightheaded, contact your doctor's office right away. After a colonoscopy, a sigmoidoscopy or a CT colonography, seek medical care immediately if you have severe abdominal pain, blood in your stool or bleeding from your anus, dizziness, or weakness, and if you think it is an emergency, call 911 or get to the nearest emergency room.
When your weight care runs through NicoCares, tell your care team in Spruce about any of the symptoms above as well, including weight loss you did not expect, because the terms ask you to report changes in your health promptly. Answers there come with no set time, so see your doctor without waiting for one, and send the care team what that doctor found.
