Colorectal cancer screening: online kit, how to do it?

THE colorectal cancer is the 2nd deadliest cancer in France, after lung cancer. Each year, it affects more than 43,000 people in France, most often after the age of 50, and is responsible for more than 17,000 deaths. Nevertheless, detected early, colorectal cancer is curable 9 times out of 10. In France, the people aged 50 to 74 can free get done screen for this cancer by asking for their screening kit. This test to be done at home must then be sent to the laboratory for analysis. The approach is fully covered by health insurance.

→ Cconsult his doctor. He gives the test to the patient and explains how to use it at home.

→ Order it online on the Health Insurance website monkit.depistage-colorectal.fr.

→ Pick it up at the pharmacy without an appointment. 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).

The kit contains a “immunological” test which look for the presence of blood in the stool. The kit contains a blue envelope (below) And 3 flaps :

• 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

Once the test is retrieved:

• 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 stem 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.

Deadline: where to see your results?

The results are available online, via the website www.resultat-depistage.fr. THE test result is usually available within 15 days. The realization of a colonoscopy is indicated as soon as possible in the event of a positive test.

Positive result: what does that mean?

→ 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.

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 stage, therefore serious” explains Dr. Bredin. I’review 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. There bowel preparation is carried out in two stages (the day before and the morning of the exam). It exists in different ways (tablets, drinks to be reconstituted whose taste has been improved)“. warns Dr. Bredin.

Negative test: what to do?

If the test is negative (96% of cases), it means that no bleeding was 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. blood is found in the stool during the screening test, a colonoscopy is performed.

In case of visible blood in the stool, a colonoscopy should be done directly.

At what age should you be screened for colorectal cancer?

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. “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. THE patients from the other two groups come under a targeted screening directly by colonoscopy. In case of visible blood in the stool, unusual change in transit, unusual and prolonged abdominal pain (more than a few weeks), involuntary weight loss, or anemia, it is recommended to consult in order to schedule a colonoscopy.

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.

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.

Thanks to Dr. Christian Bredin, gastroenterologist