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Screening

Screening Is For Everyone

Almost all of the information you will read and the commercials you will see urge everyone to be screened at 50 years of age. For African Americans screening is recommended at age 45. Perhaps, even a few years earlier if you have a history of colon cancer in your family. There are even individuals and organizations that are lobbying to lower the standard age for which screening is recommended. The fact of the matter is ,this year approximately 13,000 young men and women will be diagnosed with colon cancer. That represents almost 10% of all new cases in the United States alone. We will not try to explain all of the economic, insurance, political, medical, or personal reasons why this is the case.

Does it matter what the statistics indicate if you, your spouse, your child, or someone you love or care about is diagnosed with colon cancer?

At any age:

If you experience any stomach discomfort, bleeding in your stool, or sudden weight loss, please contact your physician today.
People should talk to their doctor about starting colorectal cancer screening earlier and/or being screened more often if they have any of the following colorectal cancer risk factors:

  • a personal history of colorectal cancer or adenomatous polyps
  • a personal history of chronic inflammatory bowel disease (Crohns disease or ulcerative colitis)
  • a strong family history of colorectal cancer or polyps (cancer or polyps in a first-degree relative [parent, sibling, or child] younger than 60 or in 2 or more first-degree relatives of any age)
  • a known family history of hereditary colorectal cancer syndromes such as familial adenomatous polyposis (FAP) or hereditary non-polyposis colon cancer (HNPCC)

If you are not confident that your doctor is providing you with the correct information, or is not investigating the possibility of colon cancer immediately get a second opinion DEMAND THE PROPER DIAGNOSIS AND CARE. It’s you and your loved one’s lives at stake!

Colon and Rectal Cancer Screening

Beginning at age 50 (age 45 for African Americans), both men and women at average risk for developing colorectal cancer should use one of the screening tests below. The tests that are designed to find both early cancer and polyps are preferred if these tests are available to you and you are willing to have one of these more invasive tests. Of these the screening colonoscopy is the preferred test. Talk to your doctor about which test is best for you.

Tests that find polyps and cancer

  • flexible sigmoidoscopy every 5 years*
  • colonoscopy every 10 years
  • double contrast barium enema every 5 years*
  • CT colonography (virtual colonoscopy) every 5 years*

Tests that mainly find cancer

  • guaiac-based fecal occult blood test (gFOBT) every year*,**
  • fecal immunochemical test (FIT) every year*,**
  • stool DNA test (sDNA), interval uncertain*
*Colonoscopy should be done if test results are positive.
**For both gFOBT and FIT based screening, the take-home method should be used and the manufacturer’s specimen collection instructions should be followed. A gFOBT or FIT done during a digital rectal exam in the doctor's office is not adequate for screening.

If you cannot afford a colonoscopy (the gold standard for screening) or a barium enema combined with a sigmoidoscopy (almost as effective) see our page on getting help with screening.

Tests that examine the rectum, rectal tissue, and blood are used to detect (find) and diagnose colon cancer.

The following tests and procedures may be used:

  • Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
  • Fecal occult blood test: A test to check stool (solid waste) for blood that can only be seen with a microscope. Small samples of stool are placed on special cards and returned to the doctor or laboratory for testing.
  • Digital rectal exam: An exam of the rectum. The doctor or nurse inserts a lubricated, gloved finger into the rectum to feel for lumps or abnormal areas.
  • Barium enema: A series of x-rays of the lower gastrointestinal tract. A liquid that contains barium (a silver-white metallic compound) is put into the rectum. The barium coats the lower gastrointestinal tract and x-rays are taken. This procedure is also called a lower GI series.
    Barium enema procedure. The patient lies on an x-ray table. Barium liquid is put into the rectum and flows through the colon. X-rays are taken to look for abnormal areas.

  • Sigmoidoscopy: A procedure to look inside the rectum and sigmoid (lower) colon for polyps, abnormal areas, or cancer. A sigmoidoscope (a thin, lighted tube) is inserted through the rectum into the sigmoid colon. Polyps or tissue samples may be taken for biopsy.
  • Colonoscopy: A procedure to look inside the rectum and colon for polyps, abnormal areas, or cancer. A colonoscope (a thin, lighted tube) is inserted through the rectum into the colon. Polyps or tissue samples may be taken for biopsy.
  • Biopsy: The removal of cells or tissues so they can be viewed under a microscope to check for signs of cancer.
  • Virtual colonoscopy: A procedure that uses a series of x-rays called computed tomography to make a series of pictures of the colon. A computer puts the pictures together to create detailed images that may show polyps and anything else that seems unusual on the inside surface of the colon. This test is also called colonography or CT colonography.

A New Option for Colon Cancer Screening

Cologuard is a noninvasive test for colon cancer screening that identifies altered DNA and/or blood in your stool, which is associated with the possibility of colon cancer or precancer. Approved by the FDA in August of 2014, Cologuard was developed by Exact Sciences, in collaboration with researchers at Mayo Clinic. In a study of 10,000 people of average risk for colon cancer, Cologuard found 92% of cancer. Cologuard does produce false-positive results. In the clinical study, 13% of people without cancer or precancer tested positive. Cologuard must be ordered by a physician, and any positive result should be discussed with your doctor and be followed by a diagnostic colonoscopy. www.cologuardtest.com

Colonoscopy Coverage Under the Affordable Care Act

With the passage of the Affordable Care Act all individuals are required to have medical insurance. Every insurance plan must meet certain minimum requirements for what is covered. Colonoscopy coverage is a requirement for every plan going forward.

In general:

  1. Colonoscopies performed as a routine screening are covered after age 50.
  2. Normal copays would apply for colonoscopies performed for diagnostic reasons (for example, to find out the reason for rectal bleeding or other symptoms).
  3. In both cases, there may be other charges, so it is important to contact your insurance provider before the procedure.

If you have a new health insurance plan or insurance policy beginning on or after September 23, 2010, colorectal cancer screening for adults over 50 must be covered without your having to pay a copayment or co-insurance or meet your deductible. This applies only when these services are delivered by a network provider. If your plan started before September 23, 2010, the rules about insurance coverage are covered by state laws, which vary, and other federal laws.

Even for routine screening colonoscopies, there may be other charges.  For example, you may have to pay part of the anesthesiology charges. Check with your insurance provider before your procedure to confirm what is covered under your policy.

The bottom line? It is important to do your homework ahead of time so you don’t get any surprise bills, but don’t let this deter you from scheduling a colonoscopy.  A colonoscopy can find non-cancerous colorectal polyps and remove them before they become cancerous. If colorectal cancer does occur, early detection and treatment dramatically increase chances of survival.  The relative 5-year survival rate for colorectal cancer when diagnosed at an early stage before it has spread is about 90%.

For more information:
http://www.hhs.gov/healthcare/facts/factsheets/2010/07/preventive-services-list.html#CoveredPreventiveServicesforAdults
http://www.cancer.org/cancer/colonandrectumcancer/moreinformation/colonandrectumcancerearlydetection/colorectal-cancer-early-detection-screening-coverage-laws

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