A new study from Oakland, Calif.-based Kaiser Permanente found that patients who receive a positive fecal test often delay undergoing colonoscopy – the recommended procedure following a positive diagnosis.
Instead of undergoing colonoscopies, the study found that patients instead repeat fecal testing. Among patients who repeated the fecal test, over half did not have a colonoscopy within a year.
The study examined data from hundreds of thousands of medical records and interviewed dozens of patients between the ages 50 and 89 who had positive fecal tests between 2010 and 2018 at four different health systems.
It found that only 41% of patients who had two positive fecal tests scheduled a colonoscopy within a year of their initial positive fecal test.
Those with an initial positive test followed by a negative second test were significantly less likely to have a colonoscopy than those with two positive tests, and patients ages 65 to 89 who had a greater number of chronic conditions were significantly more likely to do a repeat fecal test than go for a colonoscopy.
At the beginning of October, the FDA approved the Cologuard Plus test, a next-generation, multitarget stool DNA test. While fecal testing is a good option for some patients, colonoscopy remains the gold standard for colorectal cancer screenings.
In a trial of 19,000 patients, the Cologuard Plus test demonstrated 95% overall cancer sensitivity and 43% sensitivity for advanced precancerous lesions at 94% specificity.
"Colonoscopy is still the gold standard and, compared to DNA based stool and blood tests at their current pricing, still most cost-effective," Hitesh Chokshi, MD, gastroenterologist at Atlanta Gastroenterology, told Becker's.