March is Colorectal Cancer Awareness Month!

By R. Kyle Barnett, MD

Colon cancer is the second leading cause of cancer deaths among men and women combined in the United States, but most cases are preventable with appropriate screening. Efforts to increase colorectal cancer screening are urgently needed.

Who should be screened for colorectal cancer?

Currently, screening for people at average risk should start at the age of 50, although African Americans should begin screening at the age of 45. The American Cancer Society recommends screening for people at average risk of colorectal cancer at age 45, although other GI societies and insurance companies have not adapted this recommendation as of yet. Higher risk individuals (for example, those with a family history of colorectal cancer or colorectal polyps, those with a prior history of polyps or those with inflammatory bowel disease) may need to start screening at an earlier age.

How should I be screened?

Various test options are available for colorectal cancer screening.

1. Stool-based tests check the stool for signs of cancer and include fecal immunochemical test (FIT) every year, guaiac-based fecal occult blood test (FOBT) every year or stool DNA test (Cologuard) every 3 years.

2. Visual exams of the colon and rectum look at the structure of the colon and rectum for any abnormal areas and include colonoscopy every 10 years, CT colonography (virtual colonoscopy) every 5 years or flexible sigmoidoscopy every 5 years.

Note: If a person chooses to be screened with a test other than colonoscopy, any abnormal test result should be followed up with a colonoscopy.

Each test has different pros and cons, and one might be a better option for you than another. The most important thing is to GET SCREENED!

My doctor recently recommended a stool DNA test for screening. Is that test as effective as a colonoscopy?

The simple answer is No.

-Cologuard detects the presence of precancerous or cancerous cells by testing DNA from stool samples. It requires no bowel prep, no pre-test diet or medication changes, is done at home and is fairly inexpensive, often covered by insurance.

-However, studies indicate Cologuard detects only 92% of cancers and detects only 42% of precancerous polyps, making it far less effective as a preventative tool.

-It has a 13% false positive rate (meaning the test reads positive in the absence of disease), requiring further testing or confirmation with colonoscopy. This colonoscopy would not be covered by most insurance companies as a screening test; it would be considered a diagnostic test.

-Cologuard must be done for screening every 3 years, as compared to colonoscopy every 10 years.

-Colonoscopy detects more than 95% of cancers and more than 80% of all polyps, some of which could be precancerous. In addition, colonoscopy can detect other diseases and allows for the immediate removal of polyps (some of which are precancerous growths).

Does insurance cover my colorectal screening test?

The Affordable Care Act (ACA) requires both private insurers and Medicare to cover the costs of colorectal cancer screening tests. At this time, insurers are not required to (and might not) cover the cost of colorectal cancer screening before the age of 50. However, the ACA doesn’t apply to health plans that were in effect before the law was passed in 2010. Check with your insurance provider to be sure.

Make a difference in your life or the life of a loved one. Get screened! Contact Granite Peaks Gastroenterology to schedule your colon cancer screening today.

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