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You may not need a colonoscopy for screening for colon cancer.



In the United States, screening for rectal cancer is usually unpleasant. The patient's preparation begins with a liquid diet, laxatives and an awkward knowledge of where the colonoscopy camera will go. in the stool (an early sign of cancer). Tests can accurately identify cancer, according to a review and meta-analysis, published in Annals of Internal Medicine.

If the FIT returns negatively, the patient is in a clear state until the next year's test. If she returns positively, then they will have a colonoscopy, says study author Thomas Imperiale, researcher at the Regency Study Institute and Indiana University Medical Center for research and results. "If comparisons are done at a colonoscopy at all, you can significantly reduce the use of colonoscopy by making FIT," he says. "As long as it allows you to detect most of these cancers."

The latest study is based on an overview of FIT 201

4 results. "At that time less research was available," says Imperial. Analysis of his team examined 31 studies that included more than 120,000 patients. They found that the tests had a moderate to high sensitivity to cancer, that is, they detected cancer when present and had a low level of false positives.

Various studies included in the meta-analysis have different thresholds for a positive test that affects the number of detected cancers. When the test found 20 micrograms per gram of blood in the sample as positive, it found three out of four types of cancer, with a low level of false positive results, says Imperial. But when the threshold was lowered to 10 micrograms per gram, sensitivity increases. "You can take sensitivity to detecting 9 out of 10 cancers." However, it generates more false positive results. Adenomas are considered precursors of colorectal cancer. It differs from the colonoscopy, which allows physicians to visualize everything, from benign to cancerous processes. He says that these adenomas are growing very slowly, and only about 6 percent will become cancerous every year. Since FITs are intended to be used annually, a patient with a negative outcome will ideally be tested repeatedly, increasing the likelihood of detecting adenoma. Colonoscopy, on the other hand, is made only every 10 years. "You have a long time in the replay program before it hurts someone," says Ellison, who published an editorial about FIT, which was accompanied by a new study. Without defining them on the first test, this is not necessarily a problem, he says, because they are slowly growing, and if they appear on FIT in a year, they probably will not be a serious problem.

The easy annual recurrence of FIT is one of the main benefits of the test, says Imperiale. "If you repeat negative tests, you can start a stack of meaningful results, and go with not everyone who needs a colonoscopy." In the end, only about 4 percent of people with adenomas get colorectal cancer. "95% of the population will never receive it.

Colonoscopy was a standard rectal cancer screening in the United States, but the American prophylactic group, the agency that makes medical advice, does not recommend colonoscopy over the FIT, or vice versa. Instead, the organization says that the goal is to get the largest number of people being tested. In other countries, such as Canada, FIT is always the first line of screening for rectal cancer. Patients can not provide colonoscopy insurance without having the FIT.

FITs are not for everyone. Ellison would not recommend testing for people with a family history of colorectal cancer or other important risk factors. "I do not think that FIT is appropriate there," he says. Imperiales agrees and says that recognizing both options means that patients with different risk factors can make informed choices with their doctors. A patient with some risk factors that rarely turns to a doctor may be a better colonoscopy, he says. But for the marathon runner, which remains at the top of the preventive examinations, there are not many solutions for colonoscopy. "Low-risk patients who meet the requirements can achieve the best results from FIT," he says. Imperiale result to speak. "More importantly, people who have a positive need to know that they need to go through a colonoscopy," he says.

There are several FITs available from different manufacturers with varying amounts of available information and patients should ask their doctors. about the evidence of the particular version they are using, says Allison. The US Prophylactic Task Force describes in detail FIT with the best performance.

Ultimately, this study reminds that registration in the intestine does not necessarily require colonoscopy. "Non-invasive cervical cancer tests are a good option for middle-risk patients," says Imperial. "There are variants, and the only wrong option is to switch to a non-screen."


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