While home kits for colon cancer screenings seem like a convenient option, they do have limitations. Learn about the most effective screening tests.
Recently, there was news coverage surrounding people who had to pay a copayment fee for a follow-up colonoscopy after having a positive Cologuard® test. We've provided several links to the report in various publications below:
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
A point not highlighted in the report is that a large amount of these home screening outcomes might be false-positive, prompting individuals to be concerned about having colon polyps or cancer and being faced with a potential co-payment, even when the colonoscopy results turn up negative.
One recent investigation of 450 individuals, discussed at Digestive Disease Week in May 2021, found that only two percent of people who received a positive fecal test had cancer of the colon. Additionally, two-thirds of the patients received a false-positive result, which might have generated further personal expenses for a diagnostic colonoscopy to validate the findings of the home test, as described by the news publications. Moreover, a number of medical insurance providers may provide benefits for a simple colonoscopy screening conducted to detect and reduce the chance of colorectal cancer on a preventive basis.
Facts about colorectal cancer
Colon cancer is responsible for the deaths of more than 50,000 people each year and is the second most prevalent form of cancer mortality among Americans. Colorectal cancer is preventable, treatable, and beatable with early and accurate detection. Given that this cancer commonly emerges as growths in the colon, called polyps, identifying and eliminating polyps is the most effective way to minimize the risk of colon cancer. There are three forms of testing used to carry out colorectal cancer (CRC) screenings:
- Fecal Immunochemical Test (FIT) – 30% of large colon polyps are discovered
- Stool DNA (Cologuard tests) – 42% of large colon polyps are detected
- Colonoscopy – 95% of large colon polyps are identified
When it comes to screening for colon cancer, colonoscopies are regarded as the gold standard for detecting polyps in the large intestine (colon). Additionally, polyps identified during a colonoscopy screening are excised during the procedure, often reducing the requirement for further procedures.
If potential polyps are identified from a positive FIT or a Cologuard test, the patient will need to undergo a colonoscopy to remove the intestinal polyps. Unfortunately, large colorectal polyps can remain undetected with Cologuard and Fit screenings. When these growths fail to be found and taken out, it increases the chance of colorectal cancer.
The U.S. Preventive Services Task Force (USPSTF) recently advised that screenings for colorectal cancer should begin at age 45 instead of 50. As such, an additional 22 million adults between the ages of 45 – 49 should be screened for colon cancer within this year. Even though home testing kits may seem like an easier, low-cost means, the fact remains that a colonoscopy is the only screening option that has the ability to identify and hinder cancer of the colon.
Colon cancer detection vs. prevention
Cologuard tests are intended to identify cancerous indicators (such as DNA) in the stool sample sent in. But in 58% of cases, dangerous premalignant growths are not discovered at all with Cologuard kits. A Cologuard test is considered a screening test and must be repeated every three years if the beginning test generates a negative outcome. Cologuard has a reputation of rendering a significant amount of false-negative and false-positive results. According to a recent survey, two out of three of the participants who completed the Cologuard testing showed false-positive findings. Positive results from a blood or fecal screening must be followed up by a colonoscopy to confirm the findings. Since the stool or blood test is considered the "screening" evaluation, the subsequent colonoscopy is regarded as a "diagnostic" colonoscopy.
A colonoscopy is carried out to diagnose and prevent colon cancer, as it identifies over 95% of dangerous, precancerous intestinal growths and excises these areas during the process. Colonoscopies can also enable doctors to capture tissue specimens for testing to determine with greater precision if colorectal cancer is existing. Given these circumstances, colonoscopies are unequivocally more conclusive and present precautionary benefits since they get rid of any precancerous growths or abnormal cells identified in the colon.
The primary types of colonoscopies are:
Preventive/screening colonoscopies are performed commonly for patients age 45 or over with no gastric conditions in the past or present who need to undergo baseline testing to ascertain if they are likely to develop colon cancer. This type of colonoscopy examination enables the doctor to visualize any abnormal tissues within the colon, such as growths and abnormal cells. Throughout a preventive colonoscopy, polyps (which can grow into cancerous tumors) can be excised and tissue samples can be taken to determine if malignant tissue is present in the colon. A screening colonoscopy is recommended every ten years for patients aged 45 – 75 who have no symptoms and no personal or family history of GI diseases, colon polyps, or colon cancer. Although many insurance providers offer benefits for screening colonoscopies for preventive reasons, it is pertinent to check with the insurance provider first before undergoing any procedure to review coverage and gain an idea of what any estimated out-of-pocket expenses for the test might entail.
Surveillance colonoscopies are advised if an individual has a personal history of gastrointestinal disease, colon polyps, or cancer but might be asymptomatic (having no GI symptoms in the present or past). The recommendation for a surveillance colonoscopy can range according to the person's personal history. Those who have had colon polyps in the past would receive a surveillance colonoscopy and likely undergo additional surveillance examinations at shortened intervals (like on a 2 to 5-year basis). It is essential to check with the insurance carrier prior to receiving any exam to ascertain what is covered and to understand any potential out-of-pocket fees surrounding this service as it pertains to the person's policy.
Follow-up/diagnostic colonoscopies are recommended when an individual exhibits or has a history of GI symptoms, anemias, polyps, or a gastrointestinal diagnosis/disease. The person's health history and diagnoses from any previous colonoscopy exam(s) define the need for a diagnostic colonoscopy. For instance, if an individual takes a non-invasive colon cancer screening test, like FIT or Cologuard, and is provided with any kind of positive result, a follow-up colonoscopy is generally needed to verify the findings of the initial. Diagnostic colonoscopy examinations are likely to produce out-of-pocket fees. As a result, it is crucial to consult the insurance company before having a colonoscopy to review coverage amounts and any estimated out-of-pocket financial responsibility associated with this procedure.
People who are age 45 or older should undergo a colon cancer screening to create a preventive and baseline measure and foster colon health over time. It is vital to understand the disparities between colon cancer screening options and what they can reveal. All in all, colonoscopy remains the most effective type of colon cancer detection and the only colon cancer prevention option available today.
Get more information about colorectal cancer screenings in Jackson, MS
Routine colon cancer screenings are effective procedures that can protect your health and save your life. If you have more detailed inquiries regarding home screenings or want to schedule a colonoscopy, get in touch with GI Associates & Endoscopy Center today. Our Jackson, MS gastrointestinal team is ready to provide the assistance you need for long-term digestive wellness.
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
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