was told Chula in Bkk is the place to have this done as they run the actual labs.

Bkk Pattaya wants 17k for this series (one month for results) and it includes a bunch of unnecessary tests for men such as ovarian and breast cancer,

Anyone with experience taking these tests in TH ?

What you show is not a test for "cancer markers" (which as I will explain, is itself of little to no utility in screening of asymptomatic people).

It is genetic testing for gene mutations that are known to increase the risk of certain cancers.

Such mutations are a factor in only 5 - 10% of cancers. And, having them does not mean you will get cancer and definitely does not mean you now have it. Likewise, being negative for these mutations in no way rules out having cancer now or getting it in the future.

Unless you have a strong family history of specific cancers (especially with onset at comparatively early age), and there are relevant measures that can be taken to prevent or screen for this particular type of cancer which you would otherwise not do, there is no reason to get this done.

The most common example where it makes sense to have genetic testing is in women with a family history of BRCA positive breast or ovarian cancer.

When hospitals here advertise tests for cancer markers what it usually is, is so-called "tumor markers": i.e. tests that are often (but not always) elevated in certain types of cancer. With the exception of PSA, none of these tests are at all suitable for the screening of asymptomatic people, their appropriate use is in monitoring response to therapy in people with known cancer whose cancer is sensitive to one of those markers (not all cancers are)

Except for PSA (and there is some controversy even there), no public health authority recommends these tests for routine screening. Levels can be elevated for all sorts of (non-cancerous) reasons so false positives abound, leading to unnecessary invasive tests etc (one reason why private hospitals here promote them, the other reason being simple demand; people incorrectly think there is a way to be tested and know that you do not have any type of cancer. There is not.) And on the other hand, "negative" results give false sense of security when in fact, they do not rule out cancer.

It makes sense IMO to get PSA done. especially since there are now other tests that can be done first as follow up before considering biopsy. How often, depends on your age and family history. Any hospital or lab can do this. If it is elevated, should also get free PSA done as the resulting ratio can help distinguish elevations from benign causes from cancer.

Forget the "marker" tests otherwise.

From age 45 onward should also get a colonoscopy every 10 years (more often if multiple or large polyps found). Used to be from age 50 but in recent years colon cancer incidence has sharply risen in younger people. If you have a strong family history of colon cancer then could start periodic colonoscopies even earlier.

If you are a smoker or have a history of smoking equivalent to 20 pack years, annual low dose CT of lungs is strongly recommended.

A simple blood count (part of any check up package) will identify cancers of the blood.

Agree with all of that, except colonoscopy is a terrible way to screen for CRC. Colonoscopy is used a lot in the US because its so hard to get people to participate in faecal occult blood tests; tests to look for blood in your stool. Germany and the US have whats called opportunistic testing, because public participation in normal bowel health is so low. In France and the UK, the use of colonscopies is very different. A colonoscopist would be aghast that the best chance for an asymptomatic patients to be successfully diagnosed is if he, the colonscopist, manages to spot and snip for biopsy a polyp.

The UK views colonoscopy as a routine procedure, but not one without risk. Its nearly always used for investigational work, but they are also considering sigmoidoscopy as well. Someone referred, usually from the national bowel health programme (blood in the stool) is first triaged. Firstly, hardly anyone over 80 gets a colonoscopy, because of the comorbidities. Secondly, patients are checked over for other pathologies, and these have to be sorted out before a colonoscopy.

Normally a colonoscopy is horrendously expensive. UK non-NHS patient rate is £4-4500 (and not, the main private health providers are not-for-profits). In the US, Medicare covers this for screening purposes, because its better than nothing. But you ask any primary physician in the US which screening method would they recommend; 10 years $8000 colonoscopy or $10 annual FIT test, its the latter everytime. Exact Sciences have an inbetween test which combines FIT with gene market testing, for about £3000. There was a German company, Epigenomics, who came up with a simple blood test suitable for early stage screening. Cost about £300. Struggled with the FDA, because the same test also picked up Lung cancer, which the FDA didn't like. Not sure it had any traction, even when company gained approval, after theyn undertook trials in Germany to show that people prefered the blood test to the FIT test, leading to greater uptake of screening, and more cancers detected early on.

A British doctor liked the stool test, because it meant they had contact with a patient. More often than not, blood in the stool is not cancer, but that contact time allowed them to find out if anything else was going on with the patients lives.

There is significant evidence now in the US that colonoscopies are overused:

https://www.annfammed.org/content/23/Supplement_1/7683

The typical harms are being told you don't have cancer, when you do, or being told you do have cancer when you don't. There are additional harms resulting from the risk of daage to the colon.

My motther was rendered a paraplegic due to a sinus in the intestinal lining. 2 years before, she had a colonoscopy (breast cancer in remission). Its likely the procedure caused a tear. Over the years, that enabled pus to build up around the spinal cord, which would have caused pain, leading to a GP prescibing liquid morphine, because they thought it was orthopedic. Morphine depresses the immune system, leading to a coup de grace for her spinal cord; the pus cut off the blood supply and game over.

The actual damage to the spine by the infection was quite horrific, when I examined the MRIs. 3 vertebrae were dead (infection of the bone). Perhaps an emergency admission for spinal decompression might have mitigated the damage.

I fear the colonoscopy, like spinal fusion, is a procedure pushed by a certain part of the US medical profession to drive revenue. Spinal fusion rates are way higher in the US compared to Europe, but US back problems are much the same as Europe. Insurance companies are starting to push back against spinal fusion claims because they know in many cases they are unecessary. That sad case of the healthcare executive being murdered in the street might have been a result of this. The defendant had a long history of back pain, and it seems a spinal fusion that was unsuccessful. The Insurance companies decided to not continue to pay for treatment that would be fruitless. I think he lost his mind. Long term pain causes changes in brain vascularisation, which changes how we react to pain; the body creates delusions as a coping mechanism.

24 minutes ago, Roadsternut said:

Agree with all of that, except colonoscopy is a terrible way to screen for CRC. Colonoscopy is used a lot in the US because its so hard to get people to participate in faecal occult blood tests; tests to look for blood in your stool.

On the contrary, colonoscopy is considered the gold standard for screening for CRC. Fecal tests for occult blood are better than nothing but have significant limitations. There are other, better, fecal tests than occult blood, but a major disadvantage to all types of fecal testing is that they miss pre-cancerous polyps. Colonoscopy will nto only find these but they can be removed on tyhe spot. And, of course, any positive finding on fecal testing has to be followed up with a colonoscopy.

It is not in the least bit "hard" to get people in the US to participate in fecal tests, while it can indeed be hard to get people to go in for a colonscopy.

The use of fecal testing in the UK instead is a decision by the NHS based on cost constraints and the need to triage scarce resources. (With colonoscopy as the next step if positive -- or colonoscopy to start with if the patient is deemed high risk). It is NOT because fecal testing is better -- it is definitely not - but because they have decided that it is justified on cost benefit grounds/necessary given the strain the health system is under.

Colonoscopies are not usually done after age 75-80 if prior tests were completely negative since risks start to outweigh benefits as people age, though individual patient factors are also taken into account.

5 hours ago, Sheryl said:

On the contrary, colonoscopy is considered the gold standard for screening for CRC. Fecal tests for occult blood are better than nothing but have significant limitations. There are other, better, fecal tests than occult blood, but a major disadvantage to all types of fecal testing is that they miss pre-cancerous polyps. Colonoscopy will nto only find these but they can be removed on tyhe spot. And, of course, any positive finding on fecal testing has to be followed up with a colonoscopy.

It is not in the least bit "hard" to get people in the US to participate in fecal tests, while it can indeed be hard to get people to go in for a colonscopy.

The use of fecal testing in the UK instead is a decision by the NHS based on cost constraints and the need to triage scarce resources. (With colonoscopy as the next step if positive -- or colonoscopy to start with if the patient is deemed high risk). It is NOT because fecal testing is better -- it is definitely not - but because they have decided that it is justified on cost benefit grounds/necessary given the strain the health system is under.

Colonoscopies are not usually done after age 75-80 if prior tests were completely negative since risks start to outweigh benefits as people age, though individual patient factors are also taken into account.

I research in the field of CRC screening programmes across the globe. Your characterisation of the UK programme is erroneous. It was modeled after the programmes introduced in Japan and Germany. There are only two countries in the world where the majority of CRC screening is by colonoscopy. One of those countries is the country with the most expensive colonoscopies on the planet. That the majority of screenings is by colonoscopy is not due to the preference of physicians. To a man/woman, they all prefer frequent stool testing compared to infrequent colonoscopy.

The USPSTF CRC screening guidelines notes the following.

https://www.uspreventiveservicestaskforce.org/home/getfilebytoken/n4sdjxShTApRE6UxvyYuzG

The evidence is convincing that screening for colorectal cancer with fecal occult blood testing, sigmoidoscopy, or colonoscopy detects early-stage cancer and adenomatous polyps

Although colonoscopy is considered to be the reference standard against which the sensitivity of other colorectal cancer screening tests are compared, it is not perfect. Two types of studies to assess the sensitivity of colonos-copy—tandem colonoscopy studies, in which the same patient is studied twice, and studies comparing colonoscopy and CT colonography—show that colonoscopy may miss even polyps larger than 10 mm and colorectal cancer. In addition, most of the evidence about the sensitivity of colonoscopy comes from experienced examiners in research settings.

There is convincing evidence that screening with any of the 3 recommended tests reduces colorectal cancer mortality in adults age 50 to 75 years. Follow-up of positive screening test results requires colonoscopy regardless of the screening test used. Because of the harms of colonoscopy described below, the chief benefit of less invasive screening tests is that they may reduce the number of colonoscopies required and their attendant risks.

Evidence is adequate to estimate the harms of colonoscopy. In the United States, perforation of the colon occurs in an estimated 3.8 per 10 000 procedures. Serious complications—defined as deaths attributable to colonoscopy or adverse events requiring hospital admission, including perforation, major bleeding, diverticulitis, severe abdominal pain, and cardiovascular events—are significantly more common, occurring in an estimated 25 per 10 000 procedures

The strategies differ in the total number of colonoscopies that would be required to gain similar numbers of life-years. The first strategy, use of annual high-sensitivity fecal occult blood testing (sensitivity for cancer 70%) that has a false-positive rate less than 10% (that is, specificity 90%), is estimated to require the fewest colonoscopies while achieving a gain in life-years similar to that seen with screening colonoscopy every 10 years.

COLONPREV study

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)00145-X/abstract

This was a big trial of 57,000 men and women. The participants were divided into two groups: one was invited to undergo a colonoscopy, whilst the other was invited to undergo the faecal immunochemical test (FIT) every two years (five in total). The main objective was to compare mortality rates from colorectal cancer after 10 years.

The findings showed that participation in screening was higher in the faecal occult blood test group, at 40%, compared with the colonoscopy group, which was about 32%.

Colorectal cancer mortality rates after 10 years were similar in both groups: 0.22% in the colonoscopy group and 0.24% in the faecal immunochemical test group. So was the incidence of these tumours. This indicates that the test is as effective as colonoscopy in reducing colorectal cancer mortality in screening programmes.

So having something shoved up your arse once every 10 years is as effective as having your poo tested annually. But having your poo tested carried negligable risk of injury, unless you slipped on the toilet.

The rate of injury due to a colonoscopy is 3.8 per 10,000 procedures, and death is higher at 25 per 10,000 procedures; though the rate directly due to a colonoscopy is much lower, at about 3 per 100,000 procedures. About 15 million colonoscopies are carried out in the US, so about 450-500 people a year in the US essentially die with a colonoscope up their jacksie. Of the 38,000 who die indirectly because of a colonoscopy, the majority die due to a cardiovascular event. This is exactly the reason why both the UK's NHS and the French service do not perform colonoscopy as a primary screening, not because of your rubbish about saving money. The NHS can be incredibly swift at endoscopy screening. I had a uretheroscopy performed within 24 hours of referral due to suspected bladder cancer (nothing found).

US participation in CRC screening by colonoscopy is 72%, below the target of 80%. But increased participation in poo testing will result in identical cancer early diagnosis, but with much fewer inecessary colonoscopies, and concomitant reductions in injuries and deaths.

When you refer to a colonoscopy as a "gold standard" you are directly quoting the mayo clinic. Its an incorrect term. Colonoscopy is referred to as a reference standard, which means not because its the best, but its the procedure that used to determine is an alternative is better or worse.

You might have mixed up screening with diagnostics. With screening you have to think of a programme where the vast majority of people are asymptomatic. In diagnostics, the patients are symptomatic. You would not use FIT tests for diagnostics. Its not a diagnostic test. Essentially, its a test for undetected symptoms. FIT will detect haem protein in the stool long before you have bloody toilet water.

Physicians posit the arguments for and against.

https://www.gastrojournal.org/article/S0016-5085(24)00164-1/fulltext

First, although CRC is common and lethal, it is not that common and not that lethal. In the United States, the lifetime risk for CRC is about 4% (ie, 1 in 25 individuals). That means most individuals undergoing screening can never benefit because they are never destined to get or die due to CRC. They can only be harmed by screening.

Finding and removing polyps through colonoscopy can reduce cancer incidence, but polyps are a poor surrogate for the actual disease that screening aims to prevent. In an average-risk screening population, Rex et al have demonstrated adenoma detection rates (ADRs) around 50%. Of course, adding serrated lesions to this total would push “significant” polyp detection rates even higher. However, the more prevalent the precursor the less important it becomes as a risk factor for the actual disease of interest. Simply put, the vast majority of those found with polyps and exposed to the added risk of polypectomy and subsequent rounds of surveillance are never destined to develop CRC. So, the best test at detecting polyps is not necessarily the best screening test.

As for patient adherance, I have a vivid recollection of a conversation I had with a physician at the VA. All his patients were men, aged 17 to 99 years. They were generally men who would do what their doctor told them to do. He wanted them to undergo frequent FIT tests, because the FIT tests had terrific sensitivity and specificity compared to the old guaic tests that no one uses now. But would they bring in a pot of <deleted>, could he heck, so for him, for screening, colonoscopy was better than nothing.

Now in the paper, in the case for colonoscopy, contrary to your asserion, that participation in bowel health programmes is high in the US, and no problem, the doctor championing colonoscopy says that particpation would be ordinarily piss poor, and is only increased because of opportunistic colonoscopies

.....organized screening is not a widespread reality in the United States. Rather, screening occurs mostly in the opportunistic setting, where adherence to annual fecal blood testing fails dramatically. Thus, in the opportunistic setting, annual fecal testing appears impractical. To the extent the United States establishes more organized programs, FIT will gain as a first-line screening choice.

For a diagnostic test, whether its a blood test, or a imaging exam, there is a general rule of thumb. An effective test must have about 60% of tests being positive. If too few tests are positive, then you worry that the test is missing cases, and delivering false negatives. If the positivity rate is too high, then there comes a point when you say the test is pointless, and all its doing is confirming an initial diagnosis, and making no actual change in the course of treatment. Colonoscopy is primarily a diagnostic tool, not a screening tool.

Now why I get on my high horse about this. Firstly, because of my professional experience in the field. Secondly, I get aggrieved by people, especially medical professionals, who don't give patients all the options, or are dishonest in their advice. And thirdly, and this post-dates my professional experience, my personal experience, of seeing my mother, just as she was about to enjoy retirement after a career in nursing, being struckdow because of a colonoscopy. As a result, she has spent 10 years since in a wheelchair, with her primary carer being my late father, who had Alzheimers. Its been a miserable life, with no sunny side.

In truth, the primitive colonoscopy and monoclonal antibody FIT tests will get replaced. Next gen Sequencing, whether genomic or exomic, of the type you were trying to dissuade the OP from undertaking (that particular brand of test is pretty decent, but you need a good genetic counsellor) will become the paradigm. Our risk of cancer is not uniform. Our risk is as a combnation of nature (our genes) and nurture (our environment). Risk stratification will increase. At the moment, we crudely use age as some sort of way to stratify risk, when in reality, we'll likely find that age is less of a determining factor of risk that you might think. Understanding why Bob lived to 105, smoking like a chimney, drinking like a drunken sailor, but Doris only made it to 55, despite going to the gym every day. I can envisage, not far away, all neonates undergoing full genomic sequencing , GATACA style, and at various stages in your life, your physician in 2070 checks that sequence that was done in 2030, and relates information there, to behaviours. Colonoscopy already is being phased out and replaced with ultrasound colonoscopy, completely non-invasive (and less skills based, we have facing a tsunami of clinician retirements with no replacements).

Not going to comment on the posters' interpretation of medical terms, the testing practices in any given country or trial results or anything else. Instead I'm going to quote personal experience. The standard colorectal symptoms are at the bottom of this post for reference.

About 2.5 years ago I had 2 of the symptoms shown below. That was enough for me to get screened in a hospital in Bangkok. It was a 'blood in the poo' test, or perhaps better explained by the Mayo Clinic web site as "A fecal occult blood test (FOBT) is a non-invasive, at-home screening tool used to detect invisible (occult) microscopic blood in stool, which may indicate colorectal cancer, polyps, or other digestive issues. It is recommended as a routine annual screening for adults typically aged 50-75 (sometimes earlier based on risk) to detect early-stage cancers." https://www.mayoclinic.org/tests-procedures/fecal-occult-blood-test/about/pac-20394112

The test came back "negative".

Last summer I got another of the symptoms, so off I went again. This time to a clinic in Hong Kong where I am currently resident. HK has a free programme for any resident over 50. After chatting with the doctor and showing the Bangkok results she thought I was likely to be clear, but hey, as you are already here and it's free, do this stool test anyhow.

Yup, the test came back "positive".

Colonoscopy next. The prep is defo worse than the procedure, IMHO. And, yup, a tumour the size matching the Stage 3 guidelines was found. Immediate referral to hospital, CT/MRI scans (confirmed as Stage 3 with spread to lymph nodes), radiotherapy, chemo and now a 6+ hour operation aided by robotics with a 1-2 week hospital stay coming up in a few weeks. A permanent stoma will be my post-procedure "gift".

So how about the negative Bangkok test?

My understanding is that a colorectal cancer can take around 10-15 years to grow (https://www.moffitt.org/cancers/colon-cancer/faqs/how-long-does-colon-cancer-take-to-develop/). So, it is highly likely I had it 2.5 years ago. All this shows is that poo test is not infallible. It in no way denigrates the quality of the hospital in Bangkok. Just to repeat that in case someone is unable to understand this point, in no way whatsoever do I blame the hospital in Bangkok for where I am. There's a chance that 2.5 years ago there was just a polyp or 2. The pathology results came back shown what I've got is an aggressive form of tumour.

Symptoms of colon cancer can include:

• A change in bowel habits, such as more frequent diarrhea or constipation.

• Rectal bleeding or blood in the stool.

• Ongoing discomfort in the belly area, such as cramps, gas or pain.

• A feeling that the bowel doesn't empty all the way during a bowel movement.

• Weakness or tiredness.

• Losing weight without trying.

https://www.mayoclinic.org/diseases-conditions/colon-cancer/symptoms-causes/syc-20353669

If in doubt, get tested. I don't care what the normal test is where you are. Get tested.

Oh - one other thing...

Most examples I've seen talk about starting regular testing after the age of 50. Have a read of this recent article on the BBC. The man in the photo died of bowel cancer. He was 23.

11 cancers on the rise in young people - scientists find...

Researchers stress that simple lifestyle changes can still significantly reduce the risk of cancer.

Thanks to all posters for giving us a much deeper understanding of this. As we age, some of us do numerous tests but others retreat into doing nothing. I'm in the middle somewhere!

3 hours ago, Watawattana said:

Oh - one other thing...

Most examples I've seen talk about starting regular testing after the age of 50. Have a read of this recent article on the BBC. The man in the photo died of bowel cancer. He was 23.

11 cancers on the rise in young people - scientists find...

Researchers stress that simple lifestyle changes can still significantly reduce the risk of cancer.

Yes, there has been a recent (and continuing) increase in colorectal cancers in younger people.

As a result, Us reduced the recommended age for routine screening from 50+ to 45+. And anyone with symptoms (or strong family history) should be screened earlier.

4 hours ago, Watawattana said:

Not going to comment on the posters' interpretation of medical terms, the testing practices in any given country or trial results or anything else. Instead I'm going to quote personal experience. The standard colorectal symptoms are at the bottom of this post for reference.

About 2.5 years ago I had 2 of the symptoms shown below. That was enough for me to get screened in a hospital in Bangkok. It was a 'blood in the poo' test, or perhaps better explained by the Mayo Clinic web site as "A fecal occult blood test (FOBT) is a non-invasive, at-home screening tool used to detect invisible (occult) microscopic blood in stool, which may indicate colorectal cancer, polyps, or other digestive issues. It is recommended as a routine annual screening for adults typically aged 50-75 (sometimes earlier based on risk) to detect early-stage cancers." https://www.mayoclinic.org/tests-procedures/fecal-occult-blood-test/about/pac-20394112

The test came back "negative".

Last summer I got another of the symptoms, so off I went again. This time to a clinic in Hong Kong where I am currently resident. HK has a free programme for any resident over 50. After chatting with the doctor and showing the Bangkok results she thought I was likely to be clear, but hey, as you are already here and it's free, do this stool test anyhow.

Yup, the test came back "positive".

Colonoscopy next. The prep is defo worse than the procedure, IMHO. And, yup, a tumour the size matching the Stage 3 guidelines was found. Immediate referral to hospital, CT/MRI scans (confirmed as Stage 3 with spread to lymph nodes), radiotherapy, chemo and now a 6+ hour operation aided by robotics with a 1-2 week hospital stay coming up in a few weeks. A permanent stoma will be my post-procedure "gift".

So how about the negative Bangkok test?

My understanding is that a colorectal cancer can take around 10-15 years to grow (https://www.moffitt.org/cancers/colon-cancer/faqs/how-long-does-colon-cancer-take-to-develop/). So, it is highly likely I had it 2.5 years ago. All this shows is that poo test is not infallible. It in no way denigrates the quality of the hospital in Bangkok. Just to repeat that in case someone is unable to understand this point, in no way whatsoever do I blame the hospital in Bangkok for where I am. There's a chance that 2.5 years ago there was just a polyp or 2. The pathology results came back shown what I've got is an aggressive form of tumour.

Symptoms of colon cancer can include:

• A change in bowel habits, such as more frequent diarrhea or constipation.

• Rectal bleeding or blood in the stool.

• Ongoing discomfort in the belly area, such as cramps, gas or pain.

• A feeling that the bowel doesn't empty all the way during a bowel movement.

• Weakness or tiredness.

• Losing weight without trying.

https://www.mayoclinic.org/diseases-conditions/colon-cancer/symptoms-causes/syc-20353669

If in doubt, get tested. I don't care what the normal test is where you are. Get tested.

A Fecal blood test will miss 15-30% of cancers depending on which study you refer to. That's for one isolated test, repeat testing narrows that range. This is because tumors do not always bleed or may bleed just intermittently and the test relieso n the presence of blood.

Colonoscopy misses about 6-8% assuming competent doctor.

On 4/28/2026 at 11:50 PM, Roadsternut said:

Agree with all of that, except colonoscopy is a terrible way to screen for CRC. Colonoscopy is used a lot in the US because its so hard to get people to participate in faecal occult blood tests; tests to look for blood in your stool. Germany and the US have whats called opportunistic testing, because public participation in normal bowel health is so low. In France and the UK, the use of colonscopies is very different. A colonoscopist would be aghast that the best chance for an asymptomatic patients to be successfully diagnosed is if he, the colonscopist, manages to spot and snip for biopsy a polyp.

Soon, when someone actually invents and markets one, we will have toilets that test for what you discuss.

There is no doubt that AI will provide new autonomous diagnostic tools for a wide range of potential illness.

What we really need, besides the toilet I mention, is a a low-cost bright-light-camera which can upload images of skin lesions to some AI in the cloud. The phone-camera is not the right camera for this tool.

The more this tool is used, the better the diagnostic ability of the AI.

Why don't we have this now???

Edited April 30Apr 30 by GammaGlobulin

23 minutes ago, GammaGlobulin said:

Soon, when someone actually invents and markets one, we will have toilets that test for what you discuss.

There is no doubt that AI will provide new autonomous diagnostic tools for a wide range of potential illness.

What we really need, besides the toilet I mention, is a a low-cost bright-light-camera which can upload images of skin lesions to some AI in the cloud. The phone-camera is not the right camera for this tool.

The more this tool is used, the better the diagnostic ability of the AI.

Why don't we have this now???

These toilets already exist.

https://www.gastroendonews.com/PRN/Article/07-21/Meet-the-Smart-Toilet/63917

eg Coprata.

Don't think it ever made it to market; unit cost I imagine is an issue.

55 minutes ago, Sheryl said:

A Fecal blood test will miss 15-30% of cancers depending on which study you refer to. That's for one isolated test, repeat testing narrows that range. This is because tumors do not always bleed or may bleed just intermittently and the test relieso n the presence of blood.

Colonoscopy misses about 6-8% assuming competent doctor.

Had my first screening colonoscopy at 55, free for me on German public health.

Preferred them having a good look rather than rely on any polyps, especially fresh ones, to actually be bleeding when I did the occult blood test. Came up negative. They said come back in ten years.

Second coloscopy at 65. They found a small polyp which they removed. Told me to come back in 3 years.

At 68, third procedure together with gastroscopy (another story). They found nothing at either end and told me to come back in five for the rear end again.

German public health offers a choice of occult blood or colonoscopy screening. Back then it was from 55. I believe it's earlier now but not certain. They offer descriptions, advice and statistics in a pamphlet to help candidates choose. As I understood the numbers, they suggest a couple of percent higher chance of detecting cancer or polyps with the colonoscopy.

19 minutes ago, Roadsternut said:

These toilets already exist.

https://www.gastroendonews.com/PRN/Article/07-21/Meet-the-Smart-Toilet/63917

eg Coprata.

Don't think it ever made it to market; unit cost I imagine is an issue.

As you say, this is just a prototype:

However, perhaps Japan would be a good place to begin marketing such a toilet.

The price could drop if the toilet were mass-marketed to the world.

Now that AI is improving rapidly, the technology has arrived.

1 hour ago, Sheryl said:

A Fecal blood test will miss 15-30% of cancers depending on which study you refer to. That's for one isolated test, repeat testing narrows that range. This is because tumors do not always bleed or may bleed just intermittently and the test relieso n the presence of blood.

Colonoscopy misses about 6-8% assuming competent doctor.

Simplistic. Look at NordicICC. Colonoscopy gives a false sense of security if performed just every 10 years. There is nothing wrong with a FIT test every 1-2 years, not sure why you are dead set against it.

You're quoting misleading false negatives for fecal testing in order to champion a complete reliance on a $5000 colonoscopy only. Old Guaic tests might be 30%, but no one uses those anymore. FIT, depending on brand and population, has false negativity of 7-10%,

Guaic tests were basically a chemical test for heme protein. Eating a rare steak can cause a false positive. FIT tests use antibodies to detect human hemoglobin.

25% of CRC cases have an inherited/familial component. Some peope are more at risk than others.

I agree 100++ % with Sheryl. There is no better method to identify potential cancers and polyps in the colon than the colonoscopy. Checking the stools for blood is 'really' hit or miss.

One big thing I got out of the discussion was the line about increasing the years between the colonoscopy after age 75. I like that. 👍

Thank you for the info, Sheryl. 😁

Edited April 30Apr 30 by AgMech Cowboy

1 hour ago, Roadsternut said:

You're quoting misleading false negatives for fecal testing in order to champion a complete reliance on a $5000 colonoscopy only. Old Guaic tests might be 30%, but no one uses those anymore. FIT, depending on brand and population, has false negativity of 7-10%,

A single FIT has a false negative rate of anywhere between 10 - 40% depending in which study you read and the characteristics of the study population.

I have no idea where on earth you get this idea of a screening colonoscopy costing $5,000. In Thailand, even at the top tier private hospitals, it is $800-1,000, and at Thai government hospitals around $200 - $250. In the US, the Medicare approved reimbursement is under $1,000. Other insurers will vary in what they pay but you'd be hard pressed to find one reimbursing $5,000. In the (rare) case of someone paying fully out of pocket for a colonoscopy in the US, would usually run $1,000 - $2,000.

I am not "dead set" against FITs. Though I do think that, if for whatever reason fecal testing is done instead of (rather than say in between) colonoscopy, it would usually make more sense to use a FIT-sDNA than FIT. Especially given the difficulty of ensuring adherence to screening schedules.

I also think that the ability to identify and remove pre-cancerous lesions makes colonoscopy preferrable in patients with no contrandications to the procedure. We can agree to disagree on that, I think.

There is extensive documentation from the UK NHS on the decision to use FIT rather than colonoscopy for mass screening. These clearly cite cost-benefit and logistical considerations. It is inaccurate to state that these played no role and that NHS adapted FIT solely because it was a superior screening tool.

4 hours ago, GammaGlobulin said:

As you say, this is just a prototype:

However, perhaps Japan would be a good place to begin marketing such a toilet.

The price could drop if the toilet were mass-marketed to the world.

Now that AI is improving rapidly, the technology has arrived.

Has to be <deleted> approved first. Its a Medical Device. Japan has <deleted> strange requirements on clinical trials so not sure why you are suggesting the hardest market to enter as the first market.

This is not the same as your lifestyle khazis, which are not medical devices. Japan requires clinical data based on a Japanese population. And who the <deleted> is going to pay for it. Not the Japanese government who is slashing reimbursements.

Meanwhile its a $5000 toilet, but you won't use a $20 <deleted> stick.

About as sensible as those trained laboradors used in Japan to literally smell people's arses. Dogs have an acute sense of smell, and cetain volatiles are associated with colorectal cancer, as the cells change. But that is the basis of electronic noses in development; hand held devices already being used to screen rooms for toxins. The key is a massive array of sensors.

China has started mass population surveillance of breath for cancer, using the Health Check kiosks. Drop, get checked out for cancer in the shopping mall, as well as whether you consume illicit drugs.

1 hour ago, Sheryl said:

A single FIT has a false negative rate of anywhere between 10 - 40% depending in which study you read and the characteristics of the study population.

I have no idea where on earth you get this idea of a screening colonoscopy costing $5,000. In Thailand, even at the top tier private hospitals, it is $800-1,000, and at Thai government hospitals around $200 - $250. In the US, the Medicare approved reimbursement is under $1,000. Other insurers will vary in what they pay but you'd be hard pressed to find one reimbursing $5,000. In the (rare) case of someone paying fully out of pocket for a colonoscopy in the US, would usually run $1,000 - $2,000.

I am not "dead set" against FITs. Though I do think that, if for whatever reason fecal testing is done instead of (rather than say in between) colonoscopy, it would usually make more sense to use a FIT-sDNA than FIT. Especially given the difficulty of ensuring adherence to screening schedules.

I also think that the ability to identify and remove pre-cancerous lesions makes colonoscopy preferrable in patients with no contrandications to the procedure. We can agree to disagree on that, I think.

There is extensive documentation from the UK NHS on the decision to use FIT rather than colonoscopy for mass screening. These clearly cite cost-benefit and logistical considerations. It is inaccurate to state that these played no role and that NHS adapted FIT solely because it was a superior screening tool.

Misleading. I have no idea what your background is, but you are painting a false picture.

You claim that a FIT test has a postive rate of 60% is pure fiction, or a misunderstanding of the sources.

No where did I <deleted> say price played no role. Price of course plays a role in every healthcare treatment, as it should. This is why a young man murdered a healthcare executive, due to ill conceived over use of spinal fusion surgery, because its lucrative. What you suggested was that the UK's decision was based soley on cost, a great insult to the physicians who lead that progamme (which technically in NHS England). They will <deleted> defend the clinical validity of the healthcare they deliver for their patients.

Europe, population 450 million and change, spends $2bn a year on spinal fusion surgery devices a year, with about 1.3 million surgeries. The US, population 350 million and change, spends $10.3 bn a year, with about 3 million surgeries. Is the US a nation a pain riddled invalids? No. Neither is Europe. Disease rates are very similar

And again, you have distorted my comments. NO WHERE did I say use FIT instead of Colonoscopy. FIT goes hand in hand with colonoscopy, returning colonoscopy to it true diagnostic function, rather than it being misued for mass population screening. You got all Butt Hurt when I had a mild disagreement about advice you were providing to a forum, when you are not their doctor. If you are a doctor, you should have known better rather than recommending ony one type of screening. You mostly got it right about the gene testing. You are digging yourself a hole, when you should have let it be. If you are a doctor

As for FIT-"sDNA" (sic), now you are spouting Exact Sciences's line. When Exact Science got their $3000 test approved by the FDA is was on the basis that their test demonstrated equivalent sensitivity and specificity to existing best in class FITs. Which it did, because part of their test is a FIT test. If you have problem complying with a FIT test, you will have problem complying with FIT-sDNA, because for the patient, its exactly the same, but now 100x more expensive.

If colonoscopy is so goddam successful, why are they developing ultrasound colonoscopy? Because of the unet need which is patients dying directly or indirectly due to a colonoscopy, or suffering an injury. It is a significant intervention, which does have consequences.

Ultimately, docs want to get to a simple capillary blood test, a vastly cheaper liquid biopsy, and non-invasive endoscopy, because colonoscopy does do harm. They know with the experience of PSA testing, screening rates will go through the roof. PSA, before you whack on about over diagnosis, had its problems, but it demonstrates the power of such testing, which can be done anywhere, can achieve. This was the idea behind Theranostics, which went tits up when they found their microfluidics didn't work, and the inventor killed himself.

True costs of colonoscopies are widely avaialble. Medicare is heavily subsidising the cost of a colonoscopy, with the difference being picked up by non-medicare patients (aka taxpayer). Thai labour rates are much lower that the professional and technical fees charged in the US.

https://www.acpjournals.org/doi/10.7326/M24-0375

Screening colonoscopies now account for 55% of the cost of all cancer diagnoses in the US.

I'm not sure that I fully understand in detail what is actually being discussed, although just recently I decided that as it had been about 10 years since my last colonoscopy, that I should undertake another one at Bangkok Phuket Hospital.

The price I was quoted was around 45,000 baht for a simple colonoscopy and up to 90,000 baht if removal of polyps was required, both of which I considered very expensive as my last one was between 12 and 18,000 baht (as I recall).

I know that hospitals have to make money, but the above seems to be a little too expensive to be believed and as if to further my case as regards hospitals making money, today I went for an examination on my bladder function and the total bill included a cost for a catheter (which I have to use) and the cost for it at the hospital was 16,000 baht, and when I told them that I could buy it (exactly the same) on Lazada for about 780 baht, the nurses were quite stunned.

10 hours ago, xylophone said:

I'm not sure that I fully understand in detail what is actually being discussed, although just recently I decided that as it had been about 10 years since my last colonoscopy, that I should undertake another one at Bangkok Phuket Hospital.

The price I was quoted was around 45,000 baht for a simple colonoscopy and up to 90,000 baht if removal of polyps was required, both of which I considered very expensive as my last one was between 12 and 18,000 baht (as I recall).

I know that hospitals have to make money, but the above seems to be a little too expensive to be believed and as if to further my case as regards hospitals making money, today I went for an examination on my bladder function and the total bill included a cost for a catheter (which I have to use) and the cost for it at the hospital was 16,000 baht, and when I told them that I could buy it (exactly the same) on Lazada for about 780 baht, the nurses were quite stunned.

I refuse to go to any ???? hospital for the reasons you state, IME they are just a bunch of thieving overcharging businesses to be avoided.

2 hours ago, Pumpuynarak said:

I refuse to go to any ???? hospital for the reasons you state, IME they are just a bunch of thieving overcharging businesses to be avoided.

A mistake in my post.......the hospital wanted to charge me 1600 baht (not 16,000) for a catheter which I usually buy from Lazada (same catheter, same size and make) for 780 baht. And yes I agree that they are a bunch of thieving b/stards, but I have no other option??

On 4/28/2026 at 10:08 PM, PhilipHabib said:

was told Chula in Bkk is the place to have this done as they run the actual labs.

Bkk Pattaya wants 17k for this series (one month for results) and it includes a bunch of unnecessary tests for men such as ovarian and breast cancer,

Anyone with experience taking these tests in TH ?

unnecessary tests for men such as ovarian and breast cancer,

well, not quite right. Even MEN can get Breast Cancer, though around 1%. Every year in US more than 2600 cases.

3 hours ago, Watawattana said:

Oh - one other thing...

Most examples I've seen talk about starting regular testing after the age of 50. Have a read of this recent article on the BBC. The man in the photo died of bowel cancer. He was 23.

11 cancers on the rise in young people - scientists find...

Researchers stress that simple lifestyle changes can still significantly reduce the risk of cancer.

Yes, colon cancer has recently started to occur at earlay ages and that trend is continuing.

14 hours ago, xylophone said:

I'm not sure that I fully understand in detail what is actually being discussed, although just recently I decided that as it had been about 10 years since my last colonoscopy, that I should undertake another one at Bangkok Phuket Hospital.

The price I was quoted was around 45,000 baht for a simple colonoscopy and up to 90,000 baht if removal of polyps was required, both of which I considered very expensive as my last one was between 12 and 18,000 baht (as I recall).

I know that hospitals have to make money, but the above seems to be a little too expensive to be believed and as if to further my case as regards hospitals making money, today I went for an examination on my bladder function and the total bill included a cost for a catheter (which I have to use) and the cost for it at the hospital was 16,000 baht, and when I told them that I could buy it (exactly the same) on Lazada for about 780 baht, the nurses were quite stunned.

That is indeed an unusually high price. In Phuket high tourist presence + lack of competition among private hospitals = high prices. Suggest you try Mission Hosp or Vachira, I believe the latter now has a semi-private channel. Or, if you have another readon to travel there are many options in Bangkok both public and private.

https://www.mission-hospital.org/e

Other thing you vould do is wait for a promtion price. Often happens towards end of year.

A few months ago I did my colonoscopy at Pattaya Bangkok Hospital. They had a promotion running and it only cost 21,000-baht total. Great deal with great service. Highly recommended. My Cigna insurance paid for the whole thing. I paid the hospital in cash and sent Cigna the bill which they paid the next day.

On 4/29/2026 at 12:29 AM, Sheryl said:

On the contrary, colonoscopy is considered the gold standard for screening for CRC. Fecal tests for occult blood are better than nothing but have significant limitations. There are other, better, fecal tests than occult blood, but a major disadvantage to all types of fecal testing is that they miss pre-cancerous polyps. Colonoscopy will nto only find these but they can be removed on tyhe spot. And, of course, any positive finding on fecal testing has to be followed up with a colonoscopy.

It is not in the least bit "hard" to get people in the US to participate in fecal tests, while it can indeed be hard to get people to go in for a colonscopy.

The use of fecal testing in the UK instead is a decision by the NHS based on cost constraints and the need to triage scarce resources. (With colonoscopy as the next step if positive -- or colonoscopy to start with if the patient is deemed high risk). It is NOT because fecal testing is better -- it is definitely not - but because they have decided that it is justified on cost benefit grounds/necessary given the strain the health system is under.

Colonoscopies are not usually done after age 75-80 if prior tests were completely negative since risks start to outweigh benefits as people age, though individual patient factors are also taken into account.

I have a question: Some hospitals in Thailand only want to do colonoscopy under anesthesia if patient is over 80. Why? I like to see what is going on. As I don't have any significant health issues, I plan to have further colonoscopies here. It's a lot cheaper, and no waiting list.

I response to the main post, there is testing available in the US: https://www.galleri.com/

Just now, placnx said:

I have a question: Some hospitals in Thailand only want to do colonoscopy under anesthesia if patient is over 80. Why? I like to see what is going on. As I don't have any significant health issues, I plan to have further colonoscopies here. It's a lot cheaper, and no waiting list.

I response to the main post, there is testing available in the US: https://www.galleri.com/

I'd rather get a nice nap, wake up, and it's done.