How Effective Are Colorectal Cancer Home Screenings?

There have been recent media reports surrounding patients receiving a co-payment bill for a colonoscopy following a positive Cologuard® test. Following are links to the report that appeared in a number of media.

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A factor not mentioned in the report is that several of such test results could be false-positive, causing people to be concerned about having colon polyps or cancer and facing a likely co-payment even though their colonoscopy test results are negative.

A recent study conducted of 450 people introduced at Digestive Disease Week in May 2021 revealed that only two percent of individuals who received a positive fecal test had cancer of the colon. Moreover, two-thirds of the people received a false-positive outcome, which might have caused additional personal expenses for a diagnostic colonoscopy to confirm the outcomes of the home test, as explained by the media publications. Alternatively, most insurance providers offer coverage for a simple colonoscopy screening that identifies and reduces the risk of colorectal cancer as a preventive option.

Facts about colon cancer

Colorectal cancer is responsible for the death of more than 50,000 lives each year. It's the second most prevalent type of death due to cancer among people in the United States. Colon cancer is preventable, treatable, and beatable, but only with accurate and early detection. Given that this form of cancer commonly emerges as growths in the lining of the colon (polyps), detecting and removing such areas of tissue is the most effective way to reduce the risk of colon cancer. Below are the three types of tests used to perform screenings for colorectal cancer:

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

Colonoscopy procedures remain the gold standard for identifying polyps in the large intestine (colon). Polyps found in the course of a colonoscopy are removed during the process, often minimizing the need to receive further treatments.

When potential polyps are detected during a Cologuard or positive FIT test, a colonoscopy must be performed to remove the intestinal polyps. Unfortunately, large colon polyps may not be found with Cologuard and Fit tests. If these intestinal growths aren't identified and eliminated, it raises the risk of developing colorectal cancer.

The U.S. Preventive Services Task Force (USPSTF) recently recommended that screenings for colorectal cancer begin at age 45 rather than 50. As a result, an additional 22 million adults between the ages of 45 – 49 need to be assessed for colorectal cancer this year. Though home colon cancer screening kits might appear to be a more accessible, less costly choice, the fact remains that a colonoscopy is the only screening method that can identify and hinder cancer of the colon.

Colon cancer identification vs. prevention

Cologuard tests are designed only to discover cancerous factors (including DNA) in the fecal sample collected. But 58% of the time, premalignant polyps aren't found at all with Cologuard test kits. As a screening test, Cologuard should be completed every three years if the first screening results show a negative result. Cologuard has a reputation of providing a considerable number of false-negative and false-positive conclusions. In a recent survey, two-thirds of the participants who underwent the Cologuard testing exhibited false-positive results. Positive test outcomes from a blood or fecal screening must be followed up by a colonoscopy to validate the findings. Given that the blood or stool test is deemed to be a "screening" test, the follow-up colonoscopy is considered to be the "diagnostic" colonoscopy.

A colonoscopy is carried out to identify and prevent colon and rectal cancer as it identifies over 95% of harmful, precancerous polyps and gets rid of them during the process. This procedure can also permit doctors to biopsy tissue for pathology testing to understand more accurately if cancerous cells are present. Given these circumstances, colonoscopies are, by and large, more precise and supply precautionary benefits since they can remove any growths or abnormal cells identified in the large intestine.

The main categories of colonoscopies are:

Preventive/screening colonoscopies are advised most often for asymptomatic individuals (those with no former or current digestive issues) age 45 or more who wish to establish baseline data to ascertain if they are at early risk for colon and rectal cancer. A preventive colonoscopy examination enables the physician to search for any suspicious tissues in the colon and rectum, such as abnormal cells and growths. Throughout a preventive colonoscopy, polyps (which can grow into cancerous tumors) can be eliminated and biopsies can be taken to determine if malignant cells are present in the large intestine. A screening colonoscopy is advised once every ten years for asymptomatic between the ages of 45 – 75 who have no personal or family history of colon cancer, gastrointestinal diseases, or colon polyps. The majority of insurance policies typically cover screening colonoscopies as a preventive factor. It's advisable to contact the insurance carrier before having a colonoscopy to review coverage limits and any expected out-of-pocket costs.

Surveillance colonoscopies are conducted if a person has a personal history of gastrointestinal disease, colon polyps, or cancer but may not have any GI symptoms (either past or present). The need to have a surveillance colonoscopy can differ depending on the individual's health history. Note that patients who have experienced colon polyps in the past would undergo a surveillance colonoscopy and likely have additional surveillance exams at smaller intervals (for example, on a 2 to 5-year basis). It's essential to check with the insurance carrier before receiving any procedure to know what is covered and determine any expected out-of-pocket costs for this service under the individual's insurance plan.

Follow-up/diagnostic colonoscopies are performed when an individual exhibits or has a history of anemias, polyps, gastrointestinal symptoms, or a GI disease or diagnosis. The person's health history and results from any prior colonoscopy screening(s) establish 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 generally be required to confirm the results of the screening assessment. Diagnostic colonoscopies commonly carry personal costs. As a result, it's essential to consult the insurance administrator prior to receiving any service to understand coverage amounts and any expected out-of-pocket fees for this service as it relates to the patient's policy.

If you are at least 45 or older, you need to have a screening for colon cancer to establish baseline data and help maintain your colon health over the long term. It's critical to know the variations between colorectal cancer screening procedures and what they can reveal. Colonoscopy continues to be the greatest method of diagnosing cancer and the only colon cancer prevention option.

Learn more about colon cancer screenings in Indianapolis, IN

In the event that you have additional concerns regarding home screenings or want to set up a colonoscopy, reach out to Indianapolis Gastroenterology and Hepatology. Colon cancer screenings are simple examinations that can protect your long-term health. Our Indianapolis, IN gastrointestinal specialists routinely provide colonoscopy exams are here to assist. To learn more, please schedule a consultation with our GI team today.