Some patients take second at-home fecal test to delay colonoscopy

A study of 316,443 patients shows that 7.4% of these patients repeated fecal testing rather than proceeding directly to colonoscopy as guidelines recommend, and of those who repeated home tests, over half did not have a colonoscopy within 1 year.

The work is published in the Journal of General Internal Medicine.

The study showed that among repeat testers, only 41% went on to receive a colonoscopy within one year of their initial positive fecal test. To learn more, researchers interviewed patients who had been tested twice rather than go in for their colonoscopy after the first positive test. Patients who repeated the test rather than have a colonoscopy said they did it to avoid or delay the colonoscopy, and to rule out other health conditions that might have caused the positive result. Some patients said they felt a second test would provide reassurance about the results.

"The good news is that the majority of patients in our study received a recommended colonoscopy after a positive result from a home test—this is the absolute best way we have to catch colorectal cancer early and get it treated," said lead researcher Erin E. Hahn, Ph.D., of the Kaiser Permanente Southern California Department of Research & Evaluation and the Kaiser Permanente Bernard J. Tyson School of Medicine, both in Pasadena, Calif.

"What is worrisome is we did see that some patients repeated the home tests instead of immediately getting a colonoscopy. We want to make sure that everyone gets the right kind of screening and follow-up care to catch these cancers."

Colorectal cancer is the second most common cancer-related cause of death in the United States, but screening with fecal blood tests (and more commonly now, the fecal immunochemical test [FIT]), is associated with reductions in colorectal cancer related deaths.

Fecal testing is typically more popular than having a colonoscopy as the initial step in colorectal cancer screening because it can be done at home and mailed to a laboratory. However, for those with a positive home test result, it is important to get a colonoscopy quickly.

Dr. Hahn said that she would tell physicians, "If a patient is hesitant about getting a colonoscopy after a positive FIT, it's critical to talk to them about what the FIT results really mean: There is blood in the stool that might indicate colorectal cancer, and even if the patient has a negative result next week the cancer could still be there. It's so important to find these cancers early so we can treat them effectively."