What You Should Know About Colorectal Cancer Home Screenings

What You Should Know About Colorectal Cancer Home Screenings

You may have seen the recent reports regarding people receiving a medical bill from a colonoscopy performed as a follow-up measure after having a positive Cologuard® test. If you haven’t, below are links to the story that appeared in various media.

CBS News: Woman hit with nearly $2,000 unexpected bill for colon cancer screening

U.S. News & World Report: Could Home Test for Colon Cancer Mean a Big Medical Bill to Come?

People: Missouri Woman Billed $1,900 for Colonoscopy After Previously Taking an At-Home Cancer Test

One of the points not featured in the report is that a number of these test results might be false-positive, causing people to be fearful of having colon polyps or cancer and likely facing a medical co-payment even though the outcomes of the colonoscopy are negative.

A recent research investigation administered to 450 people introduced at Digestive Disease Week in May 2021 determined that merely two percent of individuals with a positive stool test had colon cancer. And, two-thirds of the patients had a false-positive outcome, which might have caused additional out-of-pocket expenses for a diagnostic colonoscopy to validate the outcomes of the home test, as explained by the news publications. Alternatively, many insurance policies cover a simple colonoscopy screening performed to identify and minimize the chance of colon and rectal cancer as a preventive approach.

Understanding colon cancer

Colon and rectal, or cancer of the large intestine, claims the lives of over 50,000 patients annually. It’s the second most prevalent form of cancer death in the United States. With early and accurate detection, however, colon cancer is preventable, treatable, and beatable. Because this type of cancer frequently starts off as growths in the colon, known as polyps, detecting and excising such areas of tissue is the optimal way to protect against colorectal cancer. There are three types used to perform colorectal cancer (CRC) screenings:

  1. Fecal Immunochemical Test (FIT) – 30% of large polyps can be discovered
  2. Stool DNA (Cologuard tests) – 42% of large polyps can be detected
  3. Colonoscopy – 95% of large polyps can be identified

It’s important to note that colonoscopy remains the gold standard for detecting polyps in the colon. Furthermore, polyps found throughout the course of a colonoscopy are removed during the procedure, minimizing the requirement to undergo additional procedures.

If potential polyps are identified through a positive FIT or a Cologuard test, a colonoscopy is required to excise the growths. Large colorectal polyps might not be detected with FIT and Cologuard testing. When these growths aren’t found and excised, it increases the possibility of colorectal cancer.

Recently, the U.S. Preventive Services Task Force (USPSTF) recommended that screenings for colorectal cancer begin at age 45 as opposed to 50. This means an additional 22 million people age 45 – 49 should be assessed for colorectal cancer within this year alone. Even though home testing kits may appear to be a more convenient, less expensive process, it’s essential to realize that a colonoscopy exam is the only screening method that has the ability to detect and curtail the development of colon cancer.

Colon cancer identification vs. prevention

Cologuard tests are created to discover cancerous indicators (DNA) in the fecal sample collected. However, in 58% of cases, concerning precancerous growths fail to be identified at all with Cologuard. A screening test, like Cologuard, requires repeating every three years if the beginning test results are negative. Cologuard is known to render a substantial amount of false-negative and false-positive conclusions. In a recent study, two-thirds of the people who underwent the Cologuard home test had false-positive findings. Positive test outcomes following the fecal or blood test require a colonoscopy procedure to verify the results. Because the fecal or blood test is regarded as a “screening” assessment, the subsequent colonoscopy is deemed a “diagnostic” colonoscopy.

A colonoscopy procedure serves to identify and minimize the risk of colorectal cancer, as it identifies over 95% of life-threatening, precancerous polyps and removes them at the procedure time. Colonoscopies can also allow doctors to capture a sample of tissue for testing to conclude more accurately if colon cancer is occurring. As a result, colonoscopies are, by and large, more accurate and provide precautionary benefits by removing any precancerous growths detected in the colon.

The predominant types of colonoscopy procedures include:

Preventive/screening colonoscopies are performed commonly for asymptomatic patients (those with no current or past gastrointestinal (GI) symptoms) who are age 45 or older and wish to undergo a baseline screening to ascertain if they are likely to develop colon and rectal cancer. This form of colonoscopy exam lets the doctor look for any concerning areas in the colon and rectum, be it abnormal cells and growths. During a screening colonoscopy, polyps (which can become malignant) can be eliminated and biopsies can be performed to learn if malignant tissue is present in the colon. A screening colonoscopy is recommended once every ten years for patients between the ages of 45 – 75 having no symptoms and who exhibit no personal or family history of gastrointestinal diseases, colon polyps, or colon cancer. Most insurance plans offer coverage for screening colonoscopies for preventive reasons. It’s pertinent to consult with the insurance carrier before having any procedure to gain an idea of coverage amounts and any estimated out-of-pocket expenses associated with this exam under the insurance plan.

Surveillance colonoscopies are advised if a patient has a history of colon cancer, colon polyps, or GI disease but may be showing no gastrointestinal symptoms either in the past or present. The requirement of a surveillance colonoscopy may range depending on the individual’s personal history. People with a history of colon polyps would have a surveillance colonoscopy and most likely undergo further surveillance assessments at shortened intervals (such as every 2 – 5 years). It’s important to contact the insurance provider prior to receiving any exam to determine what is covered and any estimated out-of-pocket expenses surrounding this exam under the individual’s benefits.

Diagnostic/follow-up colonoscopies are carried out when a patient shows or has a history of gastrointestinal symptoms, polyps, anemias, or gastrointestinal disease or diagnosis. An individual’s medical history and results from any previous colonoscopy procedure(s) establish the need for a diagnostic colonoscopy. For example, if a patient takes a non-intrusive colon cancer screening test, such as FIT or Cologuard, and receives any kind of positive result, a diagnostic colonoscopy would generally be required to validate the outcomes of the screening assessment. Diagnostic colonoscopies commonly result in personal costs. As such, it’s critical to talk with the insurance provider ahead of having any colonoscopy to determine coverage limits and any potential personal financial responsibility.

Patients who are 45 or older should undergo screening for colon cancer as a preventive and baseline measure for future colon health. It’s imperative to realize the variations between available colorectal cancer screenings and what they can reveal. Colonoscopy continues to be the most reliable method of cancer detection and the only form of colon cancer prevention available.

Find out more about colon cancer screenings in Phoenix, AZ

Colon cancer screenings are effective examinations that can save lives. If you have further inquiries surrounding home colon and rectal cancer screenings or want to book a colonoscopy, contact Arizona Digestive Health today. Our Phoenix, AZ gastroenterologists routinely provide colonoscopy exams for colon cancer screening and are here to help you experience long-term digestive health.

Sources:

 

U.S. Preventive Services Task Force. Final Recommendation Statement, Colorectal Cancer: Screening. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/colorectal-cancer-screening

American Society for Gastrointestinal Endoscopy. https://ww-w.asge.org/home/about-asge/newsroom/media-backgrounders-detail/colorectal-cancer-screening

Society Task Force on Colorectal Cancer. The American Journal of Gastroenterology 2017;112:1016-1030. http://doi.org/10.1038/ajg.2017.174

U.S. Food and Drug Administration. Summary of Safety and Effectiveness Data (SSED). https://www.accessdata.fda.gov/cdrh_docs/pdf13/P130017b.pdf

Gastrointestinal Endoscopy Journal, Volume 93, No. 6S: 2021 AB95