Patients at Average Risk of Colorectal Cancer May Prefer Stool-Based Screenings

Individuals with an average risk of colorectal cancer said they would prefer a stool-based screening test for colorectal cancer over colonoscopy.

Most individuals with an average risk of colorectal cancer said they would prefer a stool-based screening test for colorectal cancer over colonoscopy, the method most often recommended by health care providers, according to a study published in Cancer Prevention Research. Although colorectal cancer is the second most frequent cause of cancer-related death in the United States, one-third of eligible American adults have never been screened for colorectal cancer.

The US Preventive Services Task Force (USPSTF) recommends several colorectal cancer screening methods for adults aged 50 to 75 years with an average risk for this disease. The USPSTF draft guideline update released in October 2020 recommends lowering the age of screening initiation to 45 years.

The 3 most common tests are an annual fecal immunochemical test or fecal occult blood test (FIT/FOBT), which detects blood in the stool, the multitarget stool DNA (mt-sDNA) test, which is completed every 3 years and detects altered DNA from cancer cells, precancerous polyps, or blood in the stool, and a colonoscopy every 10 years.

The researchers evaluated patient preferences through a survey conducted in collaboration with the National Opinion Research Center at the University of Chicago. The survey included short descriptions of FIT/FOBT, mt-sDNA, and colonoscopy, and asked a nationally representative sample of adults 40 to 75 years of age to choose between 2 options presented at a time. A total of 1595 respondents completed the survey and the researchers focused their analysis on a subgroup of 1062 respondents with an average risk of colon cancer.

The survey results showed that 66% of respondents preferred mt-sDNA over colonoscopy and 61% said they preferred FIT/FOBT over colonoscopy. When presented with a choice between the 2 stool-based options, 67% indicated a preference for mt-sDNA over FIT/FOBT.

Examining demographic differences, the researchers found that although mt-sDNA was preferred over colonoscopy for all age groups examined, a larger proportion of older adults (ages 65 to 75 years) said they preferred colonoscopy compared to those in younger age groups (ages 45 to 54 years). Additionally, half of Hispanic and non-Hispanic Black respondents preferred stool-based tests over colonoscopy, with a preference for mt-sDNA over FIT/FOBT. Respondents without insurance were 2.5 times more likely to prefer less expensive stool-based tests over colonoscopy.

The overall awareness of stool-based tests was about 60%, compared to 90% for colonoscopy. According to the researchers, this indicates that there is an opportunity to improve patient education about stool-based options.

Participants who were aware of stool-based tests were twice as likely to prefer mt-sDNA over FIT/FOBT, and those who had previously had a stool-based test were 2.8 times more likely to choose FIT/FOBT over colonoscopy. In contrast, respondents who had previously had a colonoscopy were less than half as likely to prefer a stool-based test over colonoscopy and those who had a provider recommend colonoscopy in the past 12 months were 40% less likely to prefer mt-sDNA over colonoscopy.

“The best colorectal cancer screening test is the one that patients are most likely to complete,” said Xuan Zhu, PhD, in a press release.


Average-risk individuals may prefer stool-based test over colonoscopy for cancer screening [news release]. EurekAlert; April 22, 2021. Accessed April 22, 2021.