As of: March 5, 2024 8:56 a.m. | from the Norddeutscher Rundfunk logo
Only 20 percent of eligible people have a colonoscopy to prevent colon cancer. Immunological fecal occult blood testing (iFOBT) is an alternative, but the result is less certain.
The process of having a colonoscopy is difficult for some people. The extensive preparation, the fear of an unpleasant procedure and sometimes the fear of pain mean that only a few people take up the offer of a purely preventive colonoscopy when they have reached the appropriate age. That’s why many people choose the easier route and opt for an immunological stool test.
Digital colon cancer early detection – stool test by post
In order to receive a stool test, those insured by some health insurance companies no longer even have to visit a doctor’s office: some health insurance companies offer digital colon cancer screening and invite those entitled to do so to order a stool test at home and send the test material by post directly to the laboratory. Insured people aged 40 and over can take part. Until now, the guidelines for early cancer detection of the Federal Joint Committee allowed insured people to take advantage of colorectal cancer screening services from the age of 50 at the earliest. However, according to experts, earlier access to early detection corresponds to the latest medical discussion – because early forms of colon cancer can develop well before the person’s 50th birthday. Thanks to early detection, there are good chances of recovery.
Further information
5 Min
In the best case scenario, colon cancer can even be prevented through good prevention. Which examinations are useful and when? 5 mins
iFOBT: What does a stool test show?
Colon cancer develops very slowly; over the years, polyps, initially harmless growths on the mucous membrane, can develop into a malignant tumor. Such tumors remain undetected for a long time because they only bleed into the intestine when they injure surrounding vessels. This blood, which cannot be seen with the naked eye, is detected by an immunological stool test. While a colonoscopy that shows no abnormalities offers a high level of security, immunological tests for stool occult blood (iFOBT) cannot fully meet this requirement. According to a recent study, a novel so-called multitarget stool RNA test (mt-sRNA test) can detect early-stage colorectal cancer better than iFOBT stool tests. The mt-sRNA test is not yet approved in Germany.
Immunological stool tests: easy sample collection at home
The stool tests can be carried out at home alone without medical assistance. To do this, you place a collecting aid in the toilet before defecation. Then you stroke the tip of the test stick over the stool sample in various places until the grooves are completely filled. The doctor’s office, or in the case of digital early detection, the test person himself, sends the test stick to the laboratory in the sample tube.
Lower safety than after colonoscopy
That sounds simple, but there are a few pitfalls – starting with the toilet bowl: a washdown can cause the sample to become watered down, making it more difficult to detect blood. There are also differences in the quality of the tests used in Germany because not all of them are equally sensitive. The Joint Federal Committee of health insurance companies, doctors and hospitals evaluated the data from medical laboratories a few years ago. Result: Some tests detect as little as four micrograms of blood in the stool, others only as low as 25. This means that the result can be positive or negative for the same person – depending on which test was used. Even with the same test there can be different results. Gastroenterologists therefore call for a uniform standard and urge caution when interpreting the results; one should not rely entirely on these tests. There are many reasons why a test can return a false negative. If anything is unclear or symptoms occur, it should either be repeated – or, ideally, followed by a colonoscopy.
Stool tests for colon cancer prevention are useful if there are special requirements
Despite all the uncertainty, immunological stool tests have their place in the early detection of colon cancer, because there are people for whom colonoscopies are difficult or impossible to perform. Some have other medical conditions that increase the risk of having a colonoscopy. In such cases, using a stool test can be of great benefit. An immunological blood stool test can also be useful for people under 50 years of age in order to find out those affected who develop cancer at an early stage. From the age of 50, a colonoscopy is useful to prevent colon cancer. While the immunological stool test is an early detection procedure, the colonoscopy is real prevention. Any polyps found during the examination can be removed immediately during the procedure.
Coverage of costs differs for women and men
The costs for both examinations, stool test and colonoscopy, are covered by health insurance companies. However, slightly different rules apply for women and men:
For women between 50 and 54, a stool test is paid for once a year. After your 55th birthday, you can have a stool test every two years – or you can opt for a colonoscopy by a specialist. As a purely precautionary measure, two colonoscopies are planned – the second usually ten years after the first. Men have a higher risk of developing colon cancer. That’s why they can have a colonoscopy twice from the age of 50, five years earlier than women. As an alternative to a colonoscopy, men between 50 and 54 can also have a stool test once a year – and after their 55th birthday every two years.
If stool tests are abnormal, you are always entitled to a colonoscopy.
Experts on the topic
Chief Physician Medical Clinic
Orchideenstieg 14
22207 Hamburg
Under the Oaks 26
26122 Oldenburg
Falkenstraße 27
30449 Hannover
Director of the Department of Gastroenterology, Hepatology and Endocrinology
Carl-Neuberg-Strasse 1
30625 Hannover
Further information
In many cases, colon cancer is a curable disease. What therapies are available – with what life expectancy? more
Too much red meat promotes the development of colon cancer. The heme iron is the reason for this. more
After colon cancer surgery, an individually tailored diet is necessary to normalize digestion again. more
This topic in the program: