The sooner intestinal cancer is detected, the better the chances of survival. Nevertheless, fewer and fewer people are participating in the screening test. In 2016, 11.4 percent fewer people in Germany used so-called hemoccult tests than they did in 2012, as Barmer-Krankenkasse determined from the billing data of legally insured persons of all insurances.
In the test, stool samples are examined for blood traces. While barely 3.9 million men and women aged 50 and over took advantage of this offer in 2012, in 2016 there were just over 3.4 million.
"It is frightening that fewer and fewer people are using colorectal cancer screening, especially against the background that colon cancer is the third most common cancer among men and the second most common among women," says Barmer's Country Manager Frank Liedtke.
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If a tumor is detected in time, the danger could be eliminated, for example by the removal of polyps in the intestine. Polyps are mucosal growths that can develop into malignant colon cancer. Every year, 73,000 people in Germany contract cancer and 30,000 die.
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For the Hamburg internist and gastroenterologist Andreas Block the decline is not particularly alarming, because he considers the investigation to be unreliable. The error rate is around 20 to 30 percent, says Block, who leads the area of prevention at the University Cancer Center. The test is not sensitive enough. That is, patients can not be sure that they are actually healthy in the event of a negative result.
In addition, the conventional stool test can not distinguish between human and animal blood. Even the consumption of a Mettbrötchen the day before could lead to a positive result. There is now a new immunological stool test, which should be less susceptible to interference. He examines the samples for antibodies that bind only to the human blood pigment hemoglobin. Blood in the stool also does not just indicate bowel cancer. It can also come from hemorrhoids or fissures.
"It's still better than not doing anything, but of course the colonoscopy is much better," says Block. Doctors could recognize 98 percent of the tumors in the approach and remove the polyps immediately. Since 2002, insured persons aged 55 and over have been entitled to a colonoscopy and to another ten years later - in other words, only two examinations.
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This regulation may have led to the decline in the stool test, Block believes. In fact, the colonoscopies for early detection have increased significantly, as the analysis of Barmer shows. The number of examinations increased from 2012 to 2017 in Germany by almost 20 percent. The absolute number of participants, however, is by far not as large as that of the Hemoccult test with around 467,000 legally insured persons. However, you have after a colonoscopy without findings ten years of rest, because polyps grow only very slowly, said Block.
"I think it would be premature to say that people get prudent and do not do hemoccult anymore." The initial "hype" in the colonoscopy, however, was also a bit decayed. Because the procedure is complicated. Just three days before certain rules in the diet must be considered. Before the actual endoscopic examination, which is made on an outpatient basis, patients are given a sedative or a light anesthetic.
The German Society for Gastroenterology, Digestive Diseases and Metabolic Diseases (DGVS) calls for the early detection of colonoscopy to be offered from the age of 50 years. The incidence of the disease increases significantly at this age. Especially men have a higher risk.
The Federal Ministry of Health has responded. From April 2019, men over the age of 50 will receive a colonoscopy or the Hämoccult test from the health insurances. For women, the colonoscopy for early detection is used from 55 years. Due to the increased life expectancy, the study also makes sense for 70- and 80-year-olds, says Block.