Stool-based colorectal cancer screening preferred over colonoscopy
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Individuals preferred stool-based screening for colorectal cancer over colonoscopy, according to survey results published in Cancer Prevention Research.
“Although several colorectal cancer screening methods have been shown to reduce colorectal cancer, nearly one-third of eligible adults in the United States have never completed colorectal cancer screening and colorectal cancer screening continues to be underutilized," Xuan Zhu, PhD, senior health services analyst at the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, and colleagues wrote. "Recommended colorectal cancer screening modalities vary with respect to safety, efficacy and cost. Better understanding of the factors that influence patient preference is, therefore, critical for improving population adherence to colorectal cancer screening."
In collaborations with the National Opinion Research Center at the University of Chicago, researchers surveyed 1,062 participants (aged 45-75 years) with an average risk for CRC to investigate preferences among three commonly used CRC screening modalities. The survey informed participants on each screening option, fecal immunochemical test or guaiac-based fecal occult blood test (FIT/gFOBT), multi-target stool DNA test (mt-sDNA) and colonoscopy, and asked participants to choose between two presented options at a time. Researchers further analyzed how demographics, awareness and experience influenced participant preferences.
When given the choice, 65.4% of respondents chose mt-sDNA over colonoscopy and 61% of respondents chose FIT/gFOBT over colonoscopy; among stool-based screening options, 66.9% of respondents chose mt-sDNA over FIT/gFOBT. According to further study analysis, a larger proportion of younger respondents (aged 45-54 years), Hispanic and non-Hispanic Black respondents and uninsured respondents preferred stool-based testing over colonoscopy. The overall awareness of stool-based testing was lower than colonoscopy awareness (60% vs. 90%) and prior experience was a significant driver for what a respondent chose in the present survey.
“Our results showed broad patient preference for stool-based tests over colonoscopy, contrasting the heavy reliance on colonoscopy for CRC screening in clinical practice," Zhu told Healio. "These findings underscore the importance of continuing to offer CRC screening options to patients and encourage health care providers to engage their patients in shared decision-making to discuss various available CRC screening options in alignment with patient needs and preferences."
Perspective
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Carole Macaron, MD
Although the available screening strategies for CRC significantly reduce death from cancer, they have not eliminated the burden of CRC. About 40-60% of CRC death in the United States are estimated to be due to missed screening opportunities, emphasizing the impact of patient adherence on the effectiveness of any screening effort. This recent national survey of more than 1,000 screen eligible U.S. adults (age 45-75) offers several key insights. While the vast majority (90.5%) of the adults surveyed were aware of screening colonoscopy, only two-thirds of them heard of stool-based tests as potential CRC screening test (60.9% for mt-sDNA and 67.1% for FIT/FOBT). Moreover, when given a choice, respondents generally preferred stool-based screening tests over a colonoscopy (65.4% for mt-sDNA over colonoscopy, 61% FIT/gFOBT over colonoscopy). Sociodemographic factors (age, race/ethnicity), presence or lack of health insurance, prior experience with a specific screening test and provider’s recommendation appear to independently influence the choice of screening.
The bottom line is that it is important to get screened, no matter which test is chosen. The best screening test is the one that gets done. The decision to proceed with a specific strategy is up to the appropriately informed patient. Each one of the available screening modalities has pros and cons and requires follow-up exams at different intervals. While at-home stool-based tests are noninvasive, convenient, and reliable, they do not eliminate the need for a colonoscopy as positive stool-based tests require a timely follow-up colonoscopy.
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