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Colorectal Cancer: Which Screening Test Should I Have?
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.
Colorectal Cancer: Which Screening Test Should I Have?
1Get the | 2Compare | 3Your | 4Your | 5Quiz | 6Your Summary |
Get the facts
Your options
- Get a stool test that you can do at home.
- Get a colonoscopy, sigmoidoscopy, or CT colonography at a doctor's office, clinic, or hospital.
This information is for people who are at average risk for colorectal cancer. Your doctor may recommend getting tested earlier or more often if you have a higher risk.
Key points to remember
- All of the screening tests work well to lower your risk of getting and dying from colorectal cancer. No matter what test you choose, regular testing can find signs of cancer early, when the cancer may be easier to treat.
- The tests differ in how they are done, how often they are done, and how you prepare for them. Your preferences are important in choosing what test to have. Think about what matters most to you as you look at what each test involves.
- No matter which test you choose, it's important that you have the test on the recommended schedule and have any follow-up visits or tests as needed. That gives you the best chance of reducing the risk of dying from colorectal cancer.
- Your risk for colorectal cancer gets higher as you get older. Talk with your doctor about your risk and when to start and stop screening.
What is colorectal cancer?
Colorectal cancer happens when cells that are not normal grow in your colon or rectum. Most people just call it "colon cancer."
These cancers usually begin as polyps. Polyps are growths attached to the inside of the colon or rectum. Colon polyps are common. Most of them don't turn into cancer. Polyps are found during some screening tests. And polyps found during a colonoscopy usually can be removed at the same time.
Why is regular screening important?
With colorectal cancer, symptoms often don't show up until the cancer is advanced. So regular screening—no matter what test you choose—makes it more likely that cancer will be found early, when the cancer may be easier to treat. And colorectal cancer can be prevented if your doctor finds and removes polyps during a colonoscopy.
Why is your family history important?
A family history of colorectal cancer makes you more likely to get it. You may need to be screened at an earlier age—and be tested more often—than other people if:
- You have a close relative with colorectal cancer. You are more likely to get colorectal cancer if:
- One of your parents, brothers, sisters, or children had it before the age of 60.
- Two or more of your parents, brothers, sisters, or children had it at any age.
- You have a family history of certain inherited gene changes. These include familial adenomatous polyposis (FAP) and Lynch syndrome. Most people who inherit these conditions will get colorectal cancer if they are not screened and treated.
What are stool tests?
Stool tests involve checking your stool for tiny amounts of blood or other signs of colorectal cancer.
Most stool tests need to be done once a year. These tests can usually be done in your home.
There are different types of stool tests:
- Fecal immunochemical test (FIT). This test checks for signs of blood in the stool. The test kit contains the things that you need for collecting small samples of stool. This test is recommended every year.
- Guaiac-based fecal occult blood test (gFOBT). This test also checks for signs of blood in the stool. The test kit contains the things that you need for collecting small samples of stool. With a gFOBT, you will be given instructions about foods to avoid in the days before the test. This test is recommended every year.
- Combined fecal immunochemical test and stool DNA (FIT-DNA). This test checks the stool for blood and genetic changes in DNA that could be signs of cancer. The test kit has a container for collecting an entire stool sample. This test is recommended every 1 to 3 years.
You can get an at-home stool test from your doctor or your local drugstore, or you can order one online. Your test kit will have instructions about how to do the test, including how to return your stool samples. Some tests provide the results right away. If your test shows a positive result (blood was found), call your doctor as soon as possible. You will need a colonoscopy.
Risks of stool tests
There is no risk from the stool test itself. For this test, you put a sample of stool on a card or you collect a stool sample.
But there are some important things to think about. If your test is positive, you will need to have a colonoscopy. This would be used to see if the stool test result is from colorectal cancer. But blood in the stool is more often caused by something other than cancer. These other causes could include hemorrhoids, ulcers, or taking aspirin. A positive test result could lead you to worry. And you might have a colonoscopy only to find out that you didn't have cancer after all.
What is colonoscopy?
Colonoscopy (say "koh-luh-NAW-skuh-pee") is a test that lets your doctor look at the inside of your entire colon. The doctor looks through a lighted tube that can bend around the corners of the colon.
With this test, the doctor can find and remove polyps, which are growths inside the colon that can turn into colorectal cancer.
When used as a screening test for colorectal cancer, this test is usually done every 10 years. If you have a colonoscopy, you won't need to have a yearly stool test. A colonoscopy may be done more often if your risk is higher than average.
Getting ready for a colonoscopy involves a very thorough cleansing of the colon ("colon prep"). The colon must be completely empty.
- For 1 to 2 days before the test, you will be on a clear liquid diet.
- On the night before the test, your doctor may have you take a prescription laxative tablet or drink a large container of laxative solution. This will make you use the bathroom often.
- If your doctor ordered a split prep, you'll do part of the prep the evening before and the other part on the day of the test.
During the test, you may be given medicine to help you relax. Many people don't remember the test afterward because they are so relaxed.
The test usually takes 30 to 45 minutes. But it may take longer if polyps are found and removed.
Risks of colonoscopy
There is a small chance for problems from having a colonoscopy. The scope may tear the lining of the colon or cause bleeding.
What is sigmoidoscopy?
Sigmoidoscopy (say "sig-moy-DAW-skuh-pee") is a test that lets your doctor look at the inside of the lower part of your colon. The doctor looks through a lighted tube that can bend around the corners of the colon.
When used to screen for colorectal cancer, this test is usually done every 5 years. Or you can have the test every 10 years if you also do the FIT stool test every year.
Getting ready for a sigmoidoscopy involves cleaning out the colon.
- For 1 to 2 days before the test, you may be on a clear liquid diet.
- You will use an enema or laxative (or both) to empty the colon before the test.
This test usually takes 5 to 15 minutes.
Risks of sigmoidoscopy
There is a small risk of problems from having a sigmoidoscopy.
There is a slight chance of piercing the colon (perforation) or causing severe bleeding by damaging the wall of the colon. But this is rare. There is also a very rare chance of a colon infection.
A sigmoidoscopy only looks at the lower part of your colon, which is where most polyps grow. But sometimes polyps grow in the upper part of your colon. Those polyps would not be seen with this test.
If your doctor finds polyps during a sigmoidoscopy, you will need to have a colonoscopy to see if there are more polyps farther up in your colon. And that test also has possible risks.
What is CT colonography?
CT colonography uses pictures taken during a CT scan to look at the colon. A thin tube is inserted into the rectum, and air is pumped through the tube into the colon. The air expands the colon so that it is easier to see on an X-ray.
When used as a screening test, it is usually done every 5 years.
Getting ready for this test involves the same cleansing of the colon that is needed for a regular colonoscopy.
If anything is found during the CT scan, you may need to have more tests, such as a colonoscopy, to make sure that you don't have cancer.
Risks of CT colonography
There is a very small risk that the lining of the colon may be injured or torn when air is pumped into the colon. This may cause bleeding.
CT colonography may find things outside the colon that might never have caused a problem if they had not been found through screening. But this test can't tell whether the problem is harmless. So you may need more tests or treatment. This can cost a lot and cause worry.
You will be exposed to radiation during this test. There is a small chance of getting cancer from having repeated CT colonographies or exposure to radiation from other sources, such as CT scans.
What do experts recommend?
Your risk for colorectal cancer gets higher as you get older. Experts recommend starting screening at age 45 for people who are at average risk.footnote 1 Talk with your doctor about your risk and when to start and stop screening.
Compare your options
Compare
What is usually involved? | | |
|---|---|---|
What are the benefits? | | |
What are the risks and side effects? | |
- You do the FIT or the gFOBT test every year. Or you do the FIT-DNA test every 1 to 3 years.
- It's done at home.
- You take samples of your stool. You may find out your results right away. Or you may need to mail the sample to a lab or your doctor's office to get the results.
- If your test shows a positive result (blood or other signs of cancer are found), you will need to have a colonoscopy.
- Screening tests work well to lower your risk of getting and dying from colorectal cancer.
- It's easy to do at home.
- A stool test costs less than other tests.
- You don't need to use laxatives or enemas.
- A "positive" result means you will need a colonoscopy to see if there is cancer in your colon. A colonoscopy is a test which also has risks.
- You have one of the following procedures:
- A colonoscopy every 10 years. It will likely be done more often if you have things that increase your risk for colorectal cancer or if polyps are found.
- A sigmoidoscopy every 5 years, or every 10 years with the FIT stool test every year.
- A CT colonography every 5 years.
- These procedures are done in a doctor's office, clinic, or hospital.
- You use laxatives to clean out your bowels.
- With colonoscopy, you are given drugs to relax. You may not remember the test at all.
- Screening tests work well to lower your risk of getting and dying from colorectal cancer.
- You don't have to do these tests as often as a stool test.
- These procedures can find polyps before they turn into cancer. Polyps anywhere in the colon usually can be removed during a colonoscopy. During a sigmoidoscopy, a doctor may be able to remove polyps from the lower colon.
- For all procedures
- Bleeding problems and a tear in the colon are rare. But they are more common with colonoscopy than with sigmoidoscopy or CT colonography.
- These procedures cost more than stool tests.
- For sigmoidoscopy
- This test only sees the lower part of the colon.
- There may be some discomfort during the test.
- If polyps are found, you will need a colonoscopy to see if there are more polyps farther up in your colon.
- For CT colonography
- If polyps are seen during this test, you will need a colonoscopy.
- There may be some discomfort during the test.
- This test may show problems that are outside the colon. Then other tests or treatment may be needed.
- You are exposed to some radiation.
Personal stories about test methods for colorectal cancer
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
No one in my family has ever had colon cancer. I decided on FIT, since I've heard that doing this test yearly is just about as good as having a colonoscopy, but with fewer risks. And I don't have to do the bowel prep.
Patrick, age 56
I've had a fecal occult blood test every year for the past 4 years, and I'm going to continue with this test. My doctor gives me the kit every year and I know what foods to avoid, so it isn't a big deal.
Jose Luis, age 54
When I turned 50, my doctor recommended a yearly FIT with a sigmoidoscopy every 10 years. I'm okay with that. I live in a rural area and I'd have to travel quite a ways to have a colonoscopy. I'd rather have my medical care close to home.
Frank, age 52
I had a colonoscopy. I didn't care for the prep. I had to drink lots of fluid and stay close to the bathroom for the whole time. But the test itself was no big deal. They didn't find any polyps. I like knowing that I don't have to do this again for 10 years.
Stella, age 58
I decided to have a CT colonography. I was glad to find out that I wouldn't need medicine to relax or sedate me, so I would be able to drive myself home after the test. I had planned to go back to work, but my sister—who had the test before—told me to take the afternoon off. I'm glad I did. I didn't have any pain, but I felt gassy and bloated for a couple of hours after the test. It was from the air that was put into my colon for the test.
Nguyen, age 50
I chose the FIT-DNA test. My medical plan offers several options. I decided on the FIT-DNA test since I can do this one at home. Now that I've done it once, I'm fine with that. The test was simple to do, and the directions were easy to follow.
Edna, age 55
What matters most to you?
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to have a stool test
Reasons to have a colonoscopy or other procedure
I'm afraid of a test that involves putting anything into my colon.
I'm not too worried about having a test that involves putting something into my colon.
I'm okay with doing a test that only checks for signs of cancer in my stool.
I want to have a test that is going to see as much as possible.
It's important to me to do testing at home, in private.
I don't mind going to a clinic or hospital to have a colonoscopy or other procedure.
I don't like the idea of drinking a lot of laxative solution (bowel prep) and spending a long time in the bathroom before a test.
I don't mind having to do the bowel prep before a test.
I don't want to miss any work for this test.
I'm not worried about missing work to have this test.
I'm willing to do a stool test every year.
I want to get the test over with and not think about it for another 10 years.
I'm worried about the cost of having a colonoscopy or other procedure.
I'm not worried about the cost of having a procedure.
My other important reasons:
My other important reasons:
Where are you leaning now?
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
Using a stool test
Having a colonoscopy or other procedure
What else do you need to make your decision?
Check the facts
Decide what's next
Certainty
1. How sure do you feel right now about your decision?
Your Summary
Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
Your decision
Next steps
Which way you're leaning
How sure you are
Your comments
Your knowledge of the facts
Key concepts that you understood
Key concepts that may need review
Getting ready to act
Patient choices
Credits and References
| Author | Ignite Healthwise, LLC Staff |
|---|---|
| Clinical Review Board | Clinical Review Board All Healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals. |
Colorectal Cancer: Which Screening Test Should I Have?
- Get the facts
- Compare your options
- What matters most to you?
- Where are you leaning now?
- What else do you need to make your decision?
1. Get the Facts
Your options
- Get a stool test that you can do at home.
- Get a colonoscopy, sigmoidoscopy, or CT colonography at a doctor's office, clinic, or hospital.
This information is for people who are at average risk for colorectal cancer. Your doctor may recommend getting tested earlier or more often if you have a higher risk.
Key points to remember
- All of the screening tests work well to lower your risk of getting and dying from colorectal cancer. No matter what test you choose, regular testing can find signs of cancer early, when the cancer may be easier to treat.
- The tests differ in how they are done, how often they are done, and how you prepare for them. Your preferences are important in choosing what test to have. Think about what matters most to you as you look at what each test involves.
- No matter which test you choose, it's important that you have the test on the recommended schedule and have any follow-up visits or tests as needed. That gives you the best chance of reducing the risk of dying from colorectal cancer.
- Your risk for colorectal cancer gets higher as you get older. Talk with your doctor about your risk and when to start and stop screening.
What is colorectal cancer?
Colorectal cancer happens when cells that are not normal grow in your colon or rectum. Most people just call it "colon cancer."
These cancers usually begin as polyps. Polyps are growths attached to the inside of the colon or rectum. Colon polyps are common. Most of them don't turn into cancer. Polyps are found during some screening tests. And polyps found during a colonoscopy usually can be removed at the same time.
Why is regular screening important?
With colorectal cancer, symptoms often don't show up until the cancer is advanced. So regular screening—no matter what test you choose—makes it more likely that cancer will be found early, when the cancer may be easier to treat. And colorectal cancer can be prevented if your doctor finds and removes polyps during a colonoscopy.
Why is your family history important?
A family history of colorectal cancer makes you more likely to get it. You may need to be screened at an earlier age—and be tested more often—than other people if:
- You have a close relative with colorectal cancer. You are more likely to get colorectal cancer if:
- One of your parents, brothers, sisters, or children had it before the age of 60.
- Two or more of your parents, brothers, sisters, or children had it at any age.
- You have a family history of certain inherited gene changes. These include familial adenomatous polyposis (FAP) and Lynch syndrome. Most people who inherit these conditions will get colorectal cancer if they are not screened and treated.
What are stool tests?
Stool tests involve checking your stool for tiny amounts of blood or other signs of colorectal cancer.
Most stool tests need to be done once a year. These tests can usually be done in your home.
There are different types of stool tests:
- Fecal immunochemical test (FIT). This test checks for signs of blood in the stool. The test kit contains the things that you need for collecting small samples of stool. This test is recommended every year.
- Guaiac-based fecal occult blood test (gFOBT). This test also checks for signs of blood in the stool. The test kit contains the things that you need for collecting small samples of stool. With a gFOBT, you will be given instructions about foods to avoid in the days before the test. This test is recommended every year.
- Combined fecal immunochemical test and stool DNA (FIT-DNA). This test checks the stool for blood and genetic changes in DNA that could be signs of cancer. The test kit has a container for collecting an entire stool sample. This test is recommended every 1 to 3 years.
You can get an at-home stool test from your doctor or your local drugstore, or you can order one online. Your test kit will have instructions about how to do the test, including how to return your stool samples. Some tests provide the results right away. If your test shows a positive result (blood was found), call your doctor as soon as possible. You will need a colonoscopy.
Risks of stool tests
There is no risk from the stool test itself. For this test, you put a sample of stool on a card or you collect a stool sample.
But there are some important things to think about. If your test is positive, you will need to have a colonoscopy. This would be used to see if the stool test result is from colorectal cancer. But blood in the stool is more often caused by something other than cancer. These other causes could include hemorrhoids, ulcers, or taking aspirin. A positive test result could lead you to worry. And you might have a colonoscopy only to find out that you didn't have cancer after all.
What is colonoscopy?
Colonoscopy (say "koh-luh-NAW-skuh-pee") is a test that lets your doctor look at the inside of your entire colon. The doctor looks through a lighted tube that can bend around the corners of the colon.
With this test, the doctor can find and remove polyps, which are growths inside the colon that can turn into colorectal cancer.
When used as a screening test for colorectal cancer, this test is usually done every 10 years. If you have a colonoscopy, you won't need to have a yearly stool test. A colonoscopy may be done more often if your risk is higher than average.
Getting ready for a colonoscopy involves a very thorough cleansing of the colon ("colon prep"). The colon must be completely empty.
- For 1 to 2 days before the test, you will be on a clear liquid diet.
- On the night before the test, your doctor may have you take a prescription laxative tablet or drink a large container of laxative solution. This will make you use the bathroom often.
- If your doctor ordered a split prep, you'll do part of the prep the evening before and the other part on the day of the test.
During the test, you may be given medicine to help you relax. Many people don't remember the test afterward because they are so relaxed.
The test usually takes 30 to 45 minutes. But it may take longer if polyps are found and removed.
Risks of colonoscopy
There is a small chance for problems from having a colonoscopy. The scope may tear the lining of the colon or cause bleeding.
What is sigmoidoscopy?
Sigmoidoscopy (say "sig-moy-DAW-skuh-pee") is a test that lets your doctor look at the inside of the lower part of your colon. The doctor looks through a lighted tube that can bend around the corners of the colon.
When used to screen for colorectal cancer, this test is usually done every 5 years. Or you can have the test every 10 years if you also do the FIT stool test every year.
Getting ready for a sigmoidoscopy involves cleaning out the colon.
- For 1 to 2 days before the test, you may be on a clear liquid diet.
- You will use an enema or laxative (or both) to empty the colon before the test.
This test usually takes 5 to 15 minutes.
Risks of sigmoidoscopy
There is a small risk of problems from having a sigmoidoscopy.
There is a slight chance of piercing the colon (perforation) or causing severe bleeding by damaging the wall of the colon. But this is rare. There is also a very rare chance of a colon infection.
A sigmoidoscopy only looks at the lower part of your colon, which is where most polyps grow. But sometimes polyps grow in the upper part of your colon. Those polyps would not be seen with this test.
If your doctor finds polyps during a sigmoidoscopy, you will need to have a colonoscopy to see if there are more polyps farther up in your colon. And that test also has possible risks.
What is CT colonography?
CT colonography uses pictures taken during a CT scan to look at the colon. A thin tube is inserted into the rectum, and air is pumped through the tube into the colon. The air expands the colon so that it is easier to see on an X-ray.
When used as a screening test, it is usually done every 5 years.
Getting ready for this test involves the same cleansing of the colon that is needed for a regular colonoscopy.
If anything is found during the CT scan, you may need to have more tests, such as a colonoscopy, to make sure that you don't have cancer.
Risks of CT colonography
There is a very small risk that the lining of the colon may be injured or torn when air is pumped into the colon. This may cause bleeding.
CT colonography may find things outside the colon that might never have caused a problem if they had not been found through screening. But this test can't tell whether the problem is harmless. So you may need more tests or treatment. This can cost a lot and cause worry.
You will be exposed to radiation during this test. There is a small chance of getting cancer from having repeated CT colonographies or exposure to radiation from other sources, such as CT scans.
What do experts recommend?
Your risk for colorectal cancer gets higher as you get older. Experts recommend starting screening at age 45 for people who are at average risk.1 Talk with your doctor about your risk and when to start and stop screening.
2. Compare your options
| Stool test | Colonoscopy or other procedures | |
|---|---|---|
| What is usually involved? |
|
|
| What are the benefits? |
|
|
| What are the risks and side effects? |
|
|
Personal stories
Personal stories about test methods for colorectal cancer
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
"No one in my family has ever had colon cancer. I decided on FIT, since I've heard that doing this test yearly is just about as good as having a colonoscopy, but with fewer risks. And I don't have to do the bowel prep."
— Patrick, age 56
"I've had a fecal occult blood test every year for the past 4 years, and I'm going to continue with this test. My doctor gives me the kit every year and I know what foods to avoid, so it isn't a big deal."
— Jose Luis, age 54
"When I turned 50, my doctor recommended a yearly FIT with a sigmoidoscopy every 10 years. I'm okay with that. I live in a rural area and I'd have to travel quite a ways to have a colonoscopy. I'd rather have my medical care close to home."
— Frank, age 52
"I had a colonoscopy. I didn't care for the prep. I had to drink lots of fluid and stay close to the bathroom for the whole time. But the test itself was no big deal. They didn't find any polyps. I like knowing that I don't have to do this again for 10 years."
— Stella, age 58
"I decided to have a CT colonography. I was glad to find out that I wouldn't need medicine to relax or sedate me, so I would be able to drive myself home after the test. I had planned to go back to work, but my sister—who had the test before—told me to take the afternoon off. I'm glad I did. I didn't have any pain, but I felt gassy and bloated for a couple of hours after the test. It was from the air that was put into my colon for the test."
— Nguyen, age 50
"I chose the FIT-DNA test. My medical plan offers several options. I decided on the FIT-DNA test since I can do this one at home. Now that I've done it once, I'm fine with that. The test was simple to do, and the directions were easy to follow."
— Edna, age 55
3. What matters most to you?
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to have a stool test
Reasons to have a colonoscopy or other procedure
I'm afraid of a test that involves putting anything into my colon.
I'm not too worried about having a test that involves putting something into my colon.
I'm okay with doing a test that only checks for signs of cancer in my stool.
I want to have a test that is going to see as much as possible.
It's important to me to do testing at home, in private.
I don't mind going to a clinic or hospital to have a colonoscopy or other procedure.
I don't like the idea of drinking a lot of laxative solution (bowel prep) and spending a long time in the bathroom before a test.
I don't mind having to do the bowel prep before a test.
I don't want to miss any work for this test.
I'm not worried about missing work to have this test.
I'm willing to do a stool test every year.
I want to get the test over with and not think about it for another 10 years.
I'm worried about the cost of having a colonoscopy or other procedure.
I'm not worried about the cost of having a procedure.
My other important reasons:
My other important reasons:
4. Where are you leaning now?
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
Using a stool test
Having a colonoscopy or other procedure
5. What else do you need to make your decision?
Check the facts
1. Will having regular screening tests lower your chances of dying from colorectal cancer?
- Yes
- No
- I'm not sure
2. Is colonoscopy a lot better at preventing deaths from cancer than the other screening tests?
- Yes
- No
- I'm not sure
3. Does having a stool test mean that I won't need to have a colonoscopy?
- Yes
- No
- I'm not sure
4. Will you have to do stool tests more often than you'll have to get a colonoscopy or other procedure?
- Yes
- No
- I'm not sure
Decide what's next
1. Do you understand the options available to you?
2. Are you clear about which benefits and side effects matter most to you?
3. Do you have enough support and advice from others to make a choice?
Certainty
1. How sure do you feel right now about your decision?
2. Check what you need to do before you make this decision.
- I'm ready to take action.
- I want to discuss the options with others.
- I want to learn more about my options.
| By | Ignite Healthwise, LLC Staff |
|---|---|
| Clinical Review Board | Clinical Review Board All Healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals. |
Note: The "printer friendly" document will not contain all the information available in the online document some Information (e.g. cross-references to other topics, definitions or medical illustrations) is only available in the online version.
Current as of: October 25, 2023
Author: Ignite Healthwise, LLC Staff
Clinical Review Board
All Healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals.
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