Comparative effectiveness data has shown stool tests to be equivalent to colonoscopy at catching cancer early in patients who don't have additional risk factors, CDC Director Dr. Tom Frieden said during a call with reporters.
Although rare, side effects from colonoscopy include adverse reactions to sedatives and perforation in the colon wall.
“When people are given more choices, they are more likely to get screened,” Frieden said. “The best test is the one that gets done.”
Prior research has shown that many people would prefer stool tests if given the option. The low rates of such screening show that “more can be done to get the word out,” said Dr. Marcus Plescia, director of the CDC's division of cancer prevention and control.
In most cases, patients receive stool tests from their physicians, Plescia said, although some health systems, including the Veterans Health Administration, mail testing kits automatically when patients turn 50. There have also been some limited efforts to distribute stool kits at health fairs, as an add-on to other preventive health services, such as flu shots, he added. “That's the kind of thing we'd like to see more of,” Plescia said.
One obstacle is that physicians often think colonoscopy is superior to stool tests at detecting colon cancer, a view CDC officials say is inaccurate.
Although individual stool tests are much less expensive than colonoscopies, Frieden said there is not a big difference in overall healthcare costs because stool tests have to be performed each year—as opposed to every 10 years for colonoscopies—and any positive stool test has to be followed up by colonoscopy.
“The bottom line is both save lives,” he said.
In its recommendations for providers, the CDC advised mailing out stool test kits with clear usage instructions and directions on how to return samples. Also, the agency said patient navigators could be helpful with testing and follow-up.
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