Should I Undergo Home Screenings for Colorectal Cancer?

You may have seen the recent media coverage about individuals who received medical co-payment bills from colonoscopies performed in the wake of positive Cologuard® tests. If you haven't, here are a few links to the report in various media.

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A specific concern not featured in the report is that a large quantity of such testing outcomes can be false-positive, prompting people to be fearful of having colon polyps or cancer and having to pay a potential co-payment even though the colonoscopy screening is negative.

One recent study introduced at Digestive Disease Week in May 2021 determined that out of 450 individuals, only two percent of those with a positive stool test had cancer of the colon. In addition, two-thirds of the individuals received a false-positive outcome, which could have caused additional out-of-pocket expenses for a colonoscopy to corroborate the results of the home test, as explained by the news publications. Alternatively, many insurance policies would likely provide benefits for a simple colonoscopy screening conducted as a preventive service to identify and reduce the risk of colorectal cancer.

About colon cancer

Colon and rectal cancer cause the death of more than 50,000 people yearly. It is the second most common type of cancer fatality among Americans. Colorectal cancer can be prevented, treated, and overcome, but only when detected accurately and early. Since this cancer often starts as growths in the colon (large intestine), called polyps, finding and removing these polyps is the most effective approach to minimize the risk of colon cancer. There are three types of tests used to perform colorectal cancer (CRC) screenings:

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

When it comes to colon cancer screenings, colonoscopy continues to be the gold standard for finding polyps. Polyps detected during a colonoscopy screening are eliminated during the procedure, excluding the requirement to undergo further procedures.

In the event that potential polyps are detected during a positive FIT or a Cologuard test, a colonoscopy must be conducted to get rid of the growths. Unfortunately, bigger colorectal polyps may go undetected with FIT and Cologuard tests. If these intestinal growths are not found and eliminated, the risk of colorectal cancer development increases.

Recently, the USPSTF (United States Preventive Services Task Force) advised that screenings for colorectal cancer begin at age 45 instead of 50. As such, an additional 22 million adults age 45 – 49 need to be screened for colorectal cancer this year alone. Even though home screening kits might seem like a more convenient, less expensive option, it is essential to realize that a colonoscopy procedure is the only screening process that has the ability to identify and thwart the development of colon cancer.

Identifying vs. preventing colorectal cancer

Cologuard is created to detect cancerous indicators (DNA) in the fecal sample collected. But 58% of the time, dangerous precancerous growths fail to be identified with Cologuard test kits. A screening test, like Cologuard, should be performed every 36 months if the beginning test results are negative. Cologuard has a reputation for providing a substantial amount of false-negative and false-positive results. In a recent study, two out of three of the patients who completed a Cologuard home screening showed false-positive outcomes. Positive outcomes from the stool or blood screening must be followed up by a colonoscopy to confirm the findings. Given that the blood or fecal test is considered a "screening" assessment, the subsequent colonoscopy is deemed the "diagnostic" colonoscopy.

A colonoscopy is carried out to detect and guard against colon cancer, as it identifies over 95% of life-threatening, precancerous intestinal polyps and gets rid of them throughout the procedure. Colonoscopies can also enable the biopsy of tissue to test and specify with greater precision if colon cancer has developed. Consequently, colonoscopies are significantly more definitive and offer preventive advantages by eliminating any precancerous polyps identified in the colon.

Three primary classifications of colonoscopy procedures are:

Screening/preventive colonoscopies are carried out typically for adults with no gastrointestinal (GI) symptoms (either prior or current) who are 45 or over and need to establish baseline testing to determine if they are at risk for colorectal cancer. This form of colonoscopy allows the physician to search for any suspicious tissues within the colon, like growths and abnormal cells. Throughout the course of a screening colonoscopy, polyps (which can become malignant) can be taken out and tissue samples can be captured to determine whether cancerous tissue is present in the large intestine. A preventive colonoscopy is advised every ten years for asymptomatic patients aged 45 – 75 who have no personal or family history of colon cancer, gastrointestinal diseases, or colon polyps. Many insurance policies frequently offer coverage for screening colonoscopies as a preventive factor. However, it is advisable to check with the insurance carrier first before having a colonoscopy to understand coverage amounts and any expected remaining costs associated with this exam under the patient's plan.

Surveillance colonoscopies are recommended when a patient has a history of GI disease, colon polyps, or cancer but may not have any past or current gastrointestinal symptoms. The need for a surveillance colonoscopy might differ according to the patient's personal history. People with a history of colon polyps would have a surveillance colonoscopy and likely undergo further surveillance evaluations at more frequent intervals (such as on a 2 to 5-year basis). It is important to contact the insurance carrier ahead of receiving any exam to understand coverage amounts and any potential out-of-pocket costs for this exam as it pertains to the patient's policy.

Follow-up/diagnostic colonoscopies are recommended if a patient exhibits or has a history of gastrointestinal diagnosis/disease, GI symptoms, anemias, or polyps. A person's health history and results from any previous colonoscopy exam(s) determine the need for a follow-up colonoscopy. For instance, if a patient takes a non-invasive screening for colorectal cancer, such as FIT or Cologuard, and is provided with any type of positive result, a diagnostic/follow-up colonoscopy would be necessary to confirm the outcomes of the screening assessment. Follow-up colonoscopy exams are likely to generate out-of-pocket payments. Consequently, it is crucial to consult the insurance administrator before undergoing any procedure to ascertain coverage amounts and any estimated personal costs associated with this medical procedure.

If you are 45 years of age or older, it is recommended that you undergo a colorectal cancer screening to establish baseline data and as a preventive measure to encourage colon health over the long term. It is important to recognize the variations among colorectal cancer screening options and how each type works. Colonoscopy remains the most effective exam for detecting cancer and is the only method of preventing colon cancer available today.

Discover more about colon cancer screenings in Tulsa, OK

Routine colon cancer screenings are simple procedures that can help ensure your long-term wellness. In the event that you have more inquiries about home colorectal cancer screenings or wish to schedule a colonoscopy, get in touch with Adult Gastroenterology Associates today. Our Tulsa, OK gastroenterologists are ready to provide the help you need for long-term GI health.