Colorectal cancer screening can save lives—but only two-thirds of adults aged 50 and over opt to get one. That rate may drop even further when you factor in the Covid-19 pandemic.
One study of electronic health records from 60 health care organizations, published in Epic Health Network Research, found a 64 percent drop in colonoscopies from mid-March 2020 to mid-June 2020 compared with non-pandemic levels.
All of this has accelerated the interest in at-home tests and not just from patients. Some health care providers, like Kaiser Permanente, are mailing colon cancer testing kits to members.
Here’s everything you need to know about at-home colorectal cancer screening and how it measures up compared to a colonoscopy.
Colorectal cancer and colonoscopies
Colorectal cancer is the second leading cause of death from cancer among adults in the United States, yet it is a preventable disease. Not only can a colonoscopy detect cancer, but it can also find precancerous polyps, allowing a doctor to remove them on the spot.
“Colonoscopy is the ‘gold standard’ not only for detecting colorectal cancer, but for preventing it from forming in the first place,” says David Robbins, MD, associate chief and program director of the division of gastroenterology at Lenox Hill Hospital in New York City.
The procedure itself is pretty painless. It involves snaking a long, flexible tube with a camera on the end into your rectum and up through your colon to hunt for problems. Thankfully, all this happens while you’re sedated.
The 24 hours beforehand, though, can be unpleasant. You need to completely (and we do mean completely) empty your bowels with a cocktail of liquids: a special and not necessarily tasty bowel preparation and laxatives. Hence the increasing popularity of at-home tests which don’t require this kind of preparation.
Colon cancer screening recommendations
For years, the U.S. Preventive Services Task Force (USPSTF) stated that all average-risk adults should start colorectal cancer screening starting at age 50. But in response to a rising case rate mostly in younger adults, it recently issued a draft screening recommendation lowering the age to 45.
This could be with a colonoscopy but also tests performed by doctors such as computed tomography (CT) colonography which uses high-tech X-rays and computer programs instead of an inserted tube. It could also be a flexible sigmoidoscopy which looks at the rectum and lower colon with the tube. Or it could be with highly sensitive stool tests.
Insurance companies usually base their coverage policies on Task Force recommendations.
The American Cancer Society had already lowered its age recommendation to 45 for average-risk individuals. It recommends the screening be done with either a stool-based test or a visual exam, such as a colonoscopy. It’s important to remember that screening tests are done for people with no symptoms.
At-home screening tests have been around in one form or another for more than 20 years, says Dr. Robbins. Three Food and Drug Administration-approved tests are now on the market.
“All three look for microscopic or invisible traces of blood in a stool sample,” explains Dr. Robbins. The three tests are:
The Fecal Immunochemical Test (FIT or iFOBT) uses antibodies to detect hemoglobin, a protein in your blood. It’s done once a year and requires you to send in a small amount of feces to a lab. Kaiser Permanente recommends that certain patients use this test starting at age 50.
The Guaiac FOBT (gFOBT) detects hemoglobin with a chemical called guaiac and is also done once a year with a small sample of feces.
The Multitarget stool DNA test (FIT-DNA) looks for small amounts of blood plus DNA from cancer cells. This test, known as Cologuard, is repeated every three years. It requires you to collect and send in an entire bowel movement.
The availability of these tests has improved screening rates, according to a 2018 JAMA Internal Medicine meta-analysis. However, if you do have an abnormal test, you should still get a colonoscopy to determine if you have cancer or something more benign like an ulcer or hemorrhoids.
You may need a prescription for some of these and, in fact, it’s much better to get screened, even at home, in partnership with a doctor.
How accurate are they?
None of the three at-home tests are as accurate as a colonoscopy. Doctors and researchers often cite an older study that found colonoscopies to have an accuracy rate of about 94 percent.
The newest test, Cologuard, “is the most accurate of the bunch and is gaining traction among primary care providers,” says Dr. Robbins.
A New England Journal of Medicine comparison from 2014 found that Cologuard detected 92.3 percent of colorectal cancers and 42 percent of large polyps while FIT detected only 74 percent of cancers and 24 percent of polyps. That study, however, was funded by the company that makes Cologuard.
The gFOBT test is even less accurate: finding between 20 percent and 50 percent of cancers. The at-home tests in general tend to have a higher rate of false positives, meaning they tag something as cancer when it actually isn’t.
Cologuard has more false positives than other at-home tests, says Craig Reickert, MD, division head of Colon and Rectal Surgery at Henry Ford Cancer Institute in Detroit.
Pros and cons of at-home colon cancer tests
One of the biggest advantages of at-home screening is that you get to skip the nasty work ahead of time.
“There is not much prep work,” says Dr. Reickert, adding that the tests are also covered by insurance and fairly easy to do. If you’re paying out of pocket, the most expensive, at $500, is Cologuard.
If the results come back positive and you need a diagnostic colonoscopy (as opposed to a screening one), there could be different copays and deductibles, he points out. (Here are some colonoscopy prep tips from a doctor.)
The biggest downside is in the area of prevention. “None of the at-home tests do a good job of detecting polyps, the growths that can turn into cancer,” says Dr. Robbins. Colonoscopies not only find polyps, even small ones, but doctors can also remove them right away.
Is there a place for at-home tests?
For certain groups, yes.
“These tests are only helpful for people at average risk for colon cancer who are not on blood thinners (other than aspirin),” says Dr. Reickert.
“If you have a personal or family history of colon polyps or colon cancer, personal history of IBD [inflammatory bowel disease], or are taking medications like Coumadin, Eliquis, Xarelto and the like, the tests are not indicated because they can be unreliable and colonoscopy is the preferred test.”
The bottom line
If you’re having symptoms like bleeding or a change in bowel habits, you should get a colonoscopy and not a stool test, says Dr. Reickert. But if you’re at average risk with no other red flags, talk to your doctor about whether an at-home test is a fit for you.
“There is no one-size-fits-all recommendation,” adds Dr. Robbins. “I advise patients to talk with their doctor about the ‘menu’ and decide together what’s best—the best is the one that gets done.”
Next, learn about these silent signs of colon cancer.
Pharmacists have plenty of knowledge to spill
Pharmacists have the inside scoop on everything from how to save money on prescriptions to common mistakes to avoid. Make the most of your visit to the drugstore and remember their recommendations and other things that pharmacists want you to know.
When you pick up your prescription, at a minimum, ask…
What is this drug? What does it do? Why am I taking it? What are the possible side effects? How should I take it? Not only does this help you to use the drug correctly, but it’s also a good way to double-check that you’re getting the right medication. Half the prescriptions taken in the U.S. each year are used improperly, and 96 percent of patients nationwide don’t ask questions about how to use their medications. Here are 10 super-important questions you must ask before taking prescription medications.
We pharmacists are human…
And we make mistakes—about two million a year. Ask us if we use bar-code systems to keep us from pulling the wrong drug off the shelf, or from giving the wrong strength of the right drug.
People assume that if it’s over-the-counter, it’s safe
An over-the-counter version of your medication might do the trick
You may just need to take more pills and forgo insurance reimbursement. But always talk to your pharmacist, and do the math.
We’ll save you money if we can
“A good part of a pharmacist’s time is spent dealing with patients and their incomes,” says pharmacist Cindy Coffey. Part of that is suggesting generic or OTC alternatives. Or if a doctor has prescribed a newer drug with no generic alternative available,” says Zlott, “I might call the doctor to suggest an older drug that’s equally effective.”
I’d think twice about using a drive-through pharmacy
The drive-through window may be convenient, but most pharmacists don’t like them. In fact, many pharmacists believe that the distractions associated with drive-through service contribute to delays, reduced efficiency and even dispensing errors. They also create an unrealistic expectation of fast-food-like service. So the next time you’re frustrated and stuck behind five cars, try to remember that getting the wrong prescription is much more dangerous than getting the wrong burger at McDonalds’s—and try to be patient.
The more I know you, the more I can help you
“The better I know you as a patient—your health history, your family, and how busy your life is—the better I can tailor medications to fit your lifestyle,” says Zlott. “You may not want to take a drug three times a day, for example, and I’ll know that if I know you.” Here are some more easy moves you can make to live longer.
Generics are a close match for most brand names
But I’d be careful with blood thinners and thyroid drugs, since small differences can have big effects.
Don’t try to get anything past us
Use one pharmacy if you can
There’s not some big computer database that tracks your drugs and flags interactions for pharmacists everywhere. If you start using a new pharmacy, make sure we know what you’re already taking.
Here’s how to avoid lines
It gets busy Monday and Tuesday evenings, since many new prescriptions and refills come in after the weekend. Also, steer clear of pharmacies on the first few days of the month—that’s when Social Security checks arrive and recipients swamp the pharmacy. Generally, the best time to visit is in the middle of the week or during the workday (but stay away at lunch hour).
Look into the $4 generics
Chains like Target, Kroger, and Walmart offer them. And it can’t hurt to ask your pharmacy if it will match the price.
Yelling at me won’t help
If I can’t reach your doctor and/or insurance company to approve a refill, there’s nothing I can do about it. “It’s frustrating,” says Zlott, “but I’d be breaking the law in some states if I gave it to you.”
Pharmacists are required by law in most states to counsel patients and answer their questions
Pharmacists are filling more prescriptions than ever
“Some pharmacies are so volume-driven that the pharmacist can’t look up all day,” says Coffey. There were a record 3.8 billion prescriptions filled in the U.S. in 2018. If I’m grumpy, there’s a reason. In most chain stores, I have 15 minutes to fill a prescription, and I get reprimanded if I’m too slow. I may also be expected to answer the phone, counsel patients, call insurance companies, and run the cash register—all while making sure you get the right medicine at the right dosage.
Sometimes we can’t read the doctor’s handwriting either
I hate your insurance company as much as you do
We can give flu shots in most states
Just ask us. Also know that when I ask, “Would you like to get a flu shot today?” I’m not just asking for your health. Flu shots are so profitable that some stores give clerks a monetary bonus at certain times of the year based on how many immunizations they sell.
People take too many drugs
Always ask to get the lowest price
When it comes to paying for prescriptions, you have to ask to get the lowest price. In a Consumer Reports study, secret shoppers who were quoted a higher price at first were often able to negotiate a discount if they just asked. So the lesson is: be pushy.
We wear white to inspire trust
Many of us require our pharmacists to wear white lab coats because we know it inspires trust. In one study, three out of four respondents judged a pharmacist in a white lab coat as more competent and approachable compared to one who was just dressed professionally. Here are some more secrets your hospital isn’t telling you.
Beware this word: phenylephrine
That’s the active ingredient in most over-the-counter cold medicines, but it’s no better than a placebo. Drugmakers started using it after pseudoephedrine, a decongestant that does work, was forced behind the counter because it was being used to make meth. Here are some medical terms you should be sure to never confuse.
Want a discount on your prescription?
Ask your doctor for a 90-day refill instead of 30. Most pharmacies offer discounts and mailing services for a three-month supply.
Electronic prescriptions are not instant
Ordinarily, they’re sent to a third-party service that then sends them to us in hourly batches. So don’t drive straight to the drugstore after your doctor sends an e-script and expect it to be ready. Call first. Here are some more things you need to know about buying medicine online.
High health-care costs aren’t lining my pockets
Even though pharmacists counsel patients every day, the federal government does not recognize us as health-care providers. That makes it very difficult for us to get reimbursed by insurance companies and government programs for the clinical services we provide.
Ask me if I can fill your prescriptions for Fido too
As long as the same drug is also prescribed for humans, I typically charge less than your vet—and I can even add chicken flavor to make it taste better.
If you’re paying out of pocket for your drugs, shop around
Prescription drug prices can vary by thousands of dollars depending on where you buy them, reports CBS News. Check first with GoodRx, a free app that compares local drug prices. And always shop around.
Consider paying with cash
Even if you have insurance, always ask me whether your prescription will cost less if you pay with cash. Sometimes the cash price is less than your insurance co-pay.
I know that having the pharmacy in the back of the store is annoying
But that design is intentional, in the hope that you’ll see something you’ll be tempted to buy as you walk through the aisles.
Try an independent drug store
If you want more personalized attention and a shorter wait, try an independent drugstore. Independents significantly outperformed chains in customer satisfaction and wait-time, according to surveys conducted by J.D. Power and Consumer Reports.
Don’t rush it
That line at the pharmacy counter may be annoying, but it’s long for a reason. Your pharmacist has a ton of things to do—and it takes time to do it right. “A pharmacist’s job to a layperson may seem simplistic, but there are many functions, from reviewing your profile to checking interactions, and making sure you’re getting the correct drug, and dosage,” says Fernando Gonzalez, RPhI, assistant professor pharmaceutical sciences division at Long Island University’s Arnold & Marie Schwartz College of Pharmacy and Health Sciences. “Patients should realize that rushing a prescription is like telling a pilot not to check the landing gear before takeoff,” he adds.
Don’t cheat on your pharmacist
It may be more convenient to sometimes use the pharmacy at work, and other times, the one closest to home, but filling your prescriptions at multiple locations removes a layer of protection from your care, which could make your prescriptions less effective—or even deadly. Drug interactions are a real thing—and that includes every drug, including those that don’t require a prescription. “Make sure all your doctors are aware of every medication you’re taking, including over-the-counter medicines, vitamins, and herbs,” urges Brian R. Malone, R. Ph, director of Pharmaceutical Services and Medication Safety Officer at NYU Winthrop Hospital on Long Island, New York. Remember that some medications cancel each other out, and others are dangerous to mix. Here are 24 secrets pain doctors won’t tell you.
Know what your prescription plan covers
Medication sticker shock is as upsetting to your pharmacist as it is to you. They want you to be able to get the medications best able to make you well, but these conversations are better had with your doctor, or insurance company, rather than your pharmacist. “It’s important for patients to have a better understanding of their insurance plans, so they know if certain medications will be covered, or if they will wind up with a huge bill. Pharmacists have become the bearer of bad news regarding plan limitations, copays, and deductibles. For example, if you have a Medicare Part D prescription plan, you may want to review your options prior to selecting a plan with your pharmacist,” recommends Gonzalez.
Brown bag it
Your conditions change over time, and so do the medications on the market which can treat them. To make sure you’re getting the best, up-to-the-minute care available, Malone suggests bringing all of your medications to your doctor, at least once a year. “Brown bagging your medicines can help you and your doctor talk about them and find out if there are any problems,” he adds. Here are some other ways to make those doctor visits work for you.
Don’t take (medical) matters into your own hands
Medications can become expensive, but don’t let cost jeopardize your health. According to Gonzalez, patients should become better educated about their medication options, including their cost, but must be proactive, and ask to be counseled, if that information isn’t readily supplied. “Today’s drugs are so potent and so expensive. Taking them correctly is the key to disease management. Many patients who have reached, or exceeded, their plans max now have to pay a higher fee for their prescriptions and tend to start extending the medications they have by not taking them as prescribed, or not taking them at all. This is a very dangerous practice,” he says. Talk to your doctor or pharmacist about plans which may be more affordable for you, and find out which drug manufacturers might be willing to provide you with free or lower-cost medications.
Ask questions
Your pharmacist lives and breathes medications all day. They are an incredibly knowledgeable resource you should use, especially if you’ve got a doctor who watches the clock during appointments. “Always ask for information about your medicines in terms you can understand,” says Malone, who suggests writing down these questions, and taking them with you, each time you fill a new prescription:
What is this medicine for?
How am I supposed to take it and for how long?
What side effects are likely? What should I do if they occur?
Is this medicine safe to take with other medicines or dietary supplements?
What food, drinks, or activities should I avoid while taking this medicine?
Make sure to write down the answers and to ask for clarification if you don’t understand something your pharmacist says. Now check out the questions doctors think you should be asking them.
Save the Internet for social networking, not for buying medicine
“Patients need to have an understanding of the dangers of purchasing medications from unapproved sources. Examples of this are invalid Internet sites, that could offer prescription drugs at dramatically low prices. In most case, these are unapproved, and may even be counterfeit. The U.S. Food & Drug Administration has the highest standards of drug approval in the world, and all manufacturers must comply. That is not true of drugs you buy from unauthorized sources, including individuals who claim to be selling prescription drugs they no longer need,” says Gonzalez.
Check and double check
Ask to look at your medication bottles before they are bagged. “Patients should check their medications before they leave the pharmacy. Look at the vial to check the name of patient, drug, doctor, and directions. Patients need to talk to the intern or pharmacist, not the cashier, to get these answers. If your medications look different, either in shape or color, always check with the pharmacist,” says Gonzalez. Don’t miss these silent signs your medication is making you sick.
Ask for help when you need it
“Have your family, or caregivers, pre-pour your medications into a medication planner if you find that you’re forgetting to take your medications,” says Malone. This can also help you avoid dangerous overdoses if you don’t remember taking your medication and accidentally take it twice.
Travel wisely
Whether you plan to travel around the world, or simply to another state, be proactive about your medications. You may forget, or lose, something you desperately need, without a pharmacy you trust nearby. “When traveling, keep a list of all your medications with both brand and generic names. There are drugs manufactured in other countries with the same brand name as in the U.S. which contain different active ingredients. Patients should also know to keep medications in their carry on bags. In addition, dosage adjustments for time zone changes may be needed. Consult with your pharmacist before you go!” stresses Gonzalez.
Check expiration dates
“Outdated medications not only lose their strength, but can also become toxic, and make you ill,” says Malone. Schedule a specific time once or twice a year, for checking expiration dates on your prescription, and over-the-counter medications, and dump anything that has expired. Some people do this when they change the batteries in their smoke detectors, or as part of an annual spring-cleaning ritual.
Turn on the lights
Don’t ever take medications without your glasses on, if you wear glasses, or in the dark or semi-dark. Believe it or not, Malone was once consulted by someone who’d put hydrocortisone cream on her toothbrush for two days straight. Another woman contacted him when she accidentally took her dog’s worm medication. Taking medication can become an automatic thing that you do without thinking. Rather than going on auto-pilot, stop for a minute, and make sure you are taking what you’re supposed to in the right dosage.
Personalize your medication bottles
If you live with others, separate everyone’s medications and, if possible, keep them in different places. If that is not practical, find a way to identify each household member’s meds, including pets. Pill bottles all look alike, and so do many pills. Try color-coding the bottles with a marker or with nail polish so you don’t take someone else’s drugs by mistake. Here are the signs you might be taking too many prescriptions.
Keep your medications at room temperature
And then there’s the one about the woman who took over-the-counter allergy pills which had been kept in a hot glove compartment for two days. She became violently ill (plus got no allergy relief). “Don’t keep medication in direct sunlight, or subject them to extreme temperatures, ever,” says Malone. Life-saving medications, such as nitroglycerin, lose their effectiveness if they are kept in too-hot temperatures for too long. In fact, all medications should be kept at room temperature, unless their label specifies that they be refrigerated. Learn the simple steps to organizing your medicine cabinet.
Don’t crush it
Malone stresses that even though pills are sometimes hard to swallow, they should never, ever be crushed up without your doctor’s OK. This is because some medications are time-released and are designed to slowly enter your bloodstream. Crushing them up eliminates their ability to work as they should and may even be dangerous. If you are having trouble swallowing your pills, do not stop taking your medication. Talk to your doctor about alternative drugs, such as those in liquid form, which will be easier for you to tolerate. Next, learn the things pharmacists keep in their own medicine cabinets.
47/47 SLIDES
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