Colorectal cancer screening: how to get your kit (and do it)?

[Mise à jour le 1er mars 2023 à 11h45] THE March is an opportunity to remind everyone French people aged 50 to 74 that they can get colorectal cancer screening free of charge (cancer or polyps which can be removed to prevent cancerous development). This is called “blue mars” this month to raise awareness of screening for colorectal cancer, the second deadliest cancer in France. This early detection allows cure 90% of cancersrecalls The League Against Cancer in a press release dated February 21, 2023. “we observe a participation rate that is still too low” she adds. Only 35% of French people concerned by this screening would do so. So it’s time topick up your kit at the pharmacy and then do the test at home. The results are available online. Path to follow.

What is the colorectal cancer screening test?

Screening consists of carrying out a so-called “immunological” test for check for blood in the stool. The kit comes in the form ofa blue envelope (below) and is composed of 3 flaps which contain:

• Part 1: a manual
• Part 2: an identification sheet for the restitution of the result + a stool collection device
• Part 3: a collection tube + a protective bag + a return envelope

THE test is to be done at home, then you send it to the laboratory for analysis. The approach is fully covered by health insurance. If of blood is found in the stool during the screening test, a colonoscopy is performed. There colonoscopy can highlight cancer, polyps or adenomas before they become cancerous. In 60 to 80% of cases, colorectal cancer follows a benign tumor, commonly called polyp. It then takes 5 to 10 years for this polyp to turn into cancer. “In its evolution, a polyp will go through different stages of transformation during which it will gradually emit blood on its surface. The presence of occult blood may suggest the presence of a polyp before it turns into cancer. In the vast majority of cases, there are no symptoms associated with the development of a polyp or an incipient tumor. This is the reason why colorectal cancers can be discovered at an advanced, and therefore serious, stage. explains Dr. Bredin.

The stool sample is taken at home usinga “testing kit”to be sent for analysis by post. The test and its interpretation are free. Once the test has been received at home or picked up at the pharmacy:

• Use the test quickly to prevent it from aging.
• If the test is not used immediately, it should be stored at a temperature between 2 and 30 degrees maximum.
• Before use, check the expiry date on the blue envelope or on the tube
• Stick the label on the identification sheet and complete the information.
• The small label is to be stuck on the tube.
• Glue the stool collection sheet to the toilet seat (there should be no contact with liquid (urine, bleach).
• Once the stool has been deposited in the collection sheet, open the collection tube and scrape the rod on the surface of the stool to cover the ridged part. Put the stem back in the tube, close and shake. The rest goes down the toilet.
• Put the tube in the protective bag and add the identification sheet. Send it all without stamp.

How do I get the colorectal cancer screening kit?

To obtain the screening kitthree possibilities:

→ Either consult the doctor. He gives the test to the patient after explaining how to use it. If the doctor deems it useful, he can also offer to do the screening test for colorectal cancer and specifies the interest. After obtaining the patient’s agreement, the doctor gives him the test and explains how to use it at home.

→ Or order the screening kit online on the Health Insurance website : monkit.depistage-colorectal.frin order to answer a few questions, and, in the absence of any particular risk, to order the test to receive it at home.

→ Either withdraw the test from the pharmacy without having to make an appointment. It suffices to belong to the age group eligible for screening (50-74 years) or present the letter from the Health Insurance if you have received it.

Since April 11, 2022, the colorectal cancer screening kit can be dispensed free of charge in pharmacies, by pharmacistswithout waiting to receive the letter from Health Insurance and go through the appointment box with your doctor (if you are in the age group eligible for screening: 50 to 74 years old).

Deadline: where to see your results?

Since 2022 the results are available online, via the DOCCR website www.resultat-depistage.fr. THE test result is usually available within 15 days. A colonoscopy is indicated as soon as possible if the test is positive.

At what age should you be screened for colorectal cancer?

THE colorectal cancer (colon cancer) is a relatively common cancer that affects both men and women, most often between 50 and 75 years old. THE screening test proposed by the Ministry of Health is to be carried out every two years to men and women aged 50 to 74. A colonoscopy may be considered earlier in the event of the appearance of suggestive symptoms or a high level of risk (antecedents for example).

How often should the screening test for colorectal cancer be repeated?

Every two years, as part of the screening program organized by the Ministry of Health in France. Between these two years, if a symptom or in case of doubt, do not hesitate to consult your doctor.

Who should be screened for colorectal cancer?

“We define 3 levels of risk” explains Dr. Bredin:

• normal risk : be aged 50 or over;
• high risk : present one or more 1st degree family history of advanced polyp or colorectal cancer (first degree: direct relatives, siblings), or present a pathology exposing to the risk of colorectal cancer (Crohn’s disease, ulcerative colitis, etc.)
• very high risk : present a genetic pathology at risk of colorectal cancer (Lynch syndrome, Familial adenomatous polyposis, etc.)

Only patients at normal risk are concerned by mass screening through the test for occult blood in the stool. Patients in the other two groups are targeted for screening directly by colonoscopy. If you have a symptom of concern, the fecal occult blood test is not relevant. Therefore, in case of visible blood in the stool, unusual change in its transit, unusual and prolonged abdominal pain (beyond a few weeks), involuntary weight loss, or anemia, it is recommended to consult in to schedule a colonoscopy.

Approximately 43,000 new cases of colorectal cancer are diagnosed each year. 18,000 die.

What if the test is positive?

A colonoscopy is indicated as soon as possible if the test is positive.

→ If the test is positive (4% of cases), it means that blood is present in your stool. The doctor sends you to a gastroenterologist for a colonoscopy to look for the origin of this bleeding:

• A precancerous lesion is involved in about 30% of cases,
• A cancerous lesion is the source of bleeding in about 8% of cases,
• In more than half of cases, colonoscopy finds no abnormality.

A positive test does not necessarily mean that there is cancer. It simply means that a colonoscopy is recommended. The doctor will send the patient to a gastroenterologist to perform a colonoscopy. This is an examination that allows you to visualize the inside of the intestine and to visualize a polyp or a tumor, and if possible, to remove it. This examination can be painful, it is often offered under light general anesthesia. “This is an invasive examination that requires intestinal preparation (purge) which will condition the quality and safety of the examination. Formerly laborious and unpleasant, the bowel preparation is carried out in two stages (the day before and the morning of the examination). It is now easier to make, and exists in various modalities (tablets, drinks to be reconstituted whose taste has been improved)“. warns Dr. Bredin.

→ If the test is negative (96% of cases), this means that no bleeding has been detected. In this case, the test will be offered to you every two years, but if you show abnormal signs between two tests (bleeding, weight loss, etc.), a medical consultation is recommended.

Is the screening test free?

The colorectal cancer screening test is free. “On a semantic level, the fecal occult blood test is not 100% reimbursed by the Health Insurance, because the Health Insurance does not finance the screening, at least not directly. The screening structures have been regionalized since 2019, and are administered through GIP (Public Interest Groups), funded by Health Insurance, but also the regions. It is therefore more accurate to say that the test is free.“ says Dr. Bredin.

Can colorectal cancer screening be done after age 75?

Age is not a contraindication to screening. Beyond 74 years, and in the absence of contraindication to a colonoscopy, screening should be done by colonoscopy. This is a targeted screening, guided by the existence of symptoms, or antecedents, and which will be offered individually by the attending physician or the gastroenterologist. If the patient has a personal or family history, and he has already performed colonoscopies, the indication for a new colonoscopy is asked by the attending physician and the gastroenterologist. As an alternative to endoscopy (which is often performed under general anesthesia), we can offer a virtual colonoscopy, which is a scanner with 3D reconstruction of the surface of the intestine. This examination is able to discover lesions whose size is beyond 3 mm. However, this examination requires preparation identical to a colonoscopy (purge) and does not allow the removal of any polyps that may be discovered.

Thanks to Dr. Christian Bredin, gastroenterologist.

Sources:

– Mars Bleu: colorectal cancer screening promotion month. Press release The League Against Cancer, February 21, 2023

– Screening figures Public Health France

– Screening assessment 2017, French National Society of Gastro-Enterology (SNFGE)