At-Home Colorectal Cancer Screening: What You Should Know

Colorectal cancer causes an estimated 50,000 deaths annually in the U.S. But it's also one of the most treatable forms of cancer—if detected early. 

In fact, it’s the only type of cancer with a screening test that allows for simultaneous treatment to prevent the disease from developing.

"Healthcare authorities, such as the American Cancer Society and the U.S. Preventive Services Task Force, recommend people at an average risk of colorectal cancer begin colon cancer screening exams at age 45 and up," said Derek Cheng, MD, a gastroenterologist at Cedars-Sinai.

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Unfortunately, only 72% of Americans who are eligible for colorectal cancer screening are currently up to date, leaving millions at risk for a cancer that is often both detectable and preventable.

One reason for the low uptake: The gold standard screening exam, a colonoscopy, requires "bowel prep," which involves fasting for hours and taking a powerful bowel-clearing substance. Other obstacles include the fear of undergoing sedation, needing to take time off work and not being able to drive yourself to and from the exam.

But colorectal cancer screening test kits are beginning to create an uptick in screening rates. These tests are safe, effective and require almost zero pre-test prep. Plus, you can do them from the comfort of your home.  

At-Home Screening Options

Every day, your colon sheds cells that line the colon into your stool, so at-home stool-collection tests can often uncover cancerous changes. For those who can't or won't do the bowel prep necessary for a colonoscopy, at-home testing kits can often detect early colon cancer lesions. And studies suggest these at-home tests are associated with increased screening rates.

While the Food and Drug Administration (FDA) has approved three types of at-home colon cancer screening tests, only two are in widespread use for their ease and effectiveness: the fecal immunochemical test (FIT) and the Cologuard test. Patients can request the test they want, but it's important to note that not every at-home kit is covered by insurance.

FIT

• This test uses antibodies to detect blood in the stool, and it's about 79% accurate at detecting colon cancer. FIT is simple, seamless and covered by most insurance companies. ‍
• The drawbacks: Since polyps may not be bleeding at the time of testing and the test relies on blood in the stool to detect cancer, patients need to repeat FIT annually. Another drawback: "FIT is prone to false positives, and a positive result warrants additional investigation through a colonoscopy," Cheng said.

Cologuard

• A pricier option than FIT, Cologuard is about 92% accurate at detecting colorectal cancer. "In addition to looking for blood in the stool, like FIT, Cologuard also searches for DNA markers of colon cancer and precancerous polyps," Cheng said. ‍
• The drawbacks: Cologuard testing needs to be repeated every three years, compared to every five to 10 years for a colonoscopy. Also, Cologuard tests are not always covered by insurance.

To do at-home colon cancer screening, you'll need a prescription from your doctor. You'll collect the sample in the comfort of your own bathroom with the prescribed kit, then mail it off to the prescribing doctor (or a lab). When the analysis is complete, your doctor will go over the results with you.

"If an at-home test comes back positive, patients still need to undergo a colonoscopy, not only to diagnose cancer, but also to remove polyps and prevent cancer," Cheng said.

Becoming Savvy About Colon Cancer Screening

There's no debate that colonoscopy is the most effective screening exam for colon cancer. The first-rate exam not only detects colon cancers with about 98% accuracy, but it also allows doctors to remove precancerous and cancerous polyps during the procedure. But patients now have other options.

"The best screening test is the one that gets done," said Cheng. "So, if people aren't willing to undergo a colonoscopy, we still want them to consider the at-home testing options."

Certain lifestyle habits can increase your risk of developing colon cancer, including smoking, heavy drinking, physical inactivity and poor dietary habits. If you have a family history of the disease or regularly engage in habits that can harm your colon, talk to your doctor about initiating colon cancer screening before age 45.