Irreplaceable Colonoscopy

If you have watched television lately, you undoubtedly have seen commercials touting at-home screening tests for colon cancer being offered as alternatives to colonoscopies. But is it an equal swap? At Associates in Digestive Health, we feel it is important to educate our patients on the misconceptions and facts of colon cancer screening.

Colonoscopies Are Proven Lifesavers


Just last month, the American Cancer Society (ACS) published new colon cancer screening guidelines, recommending that patients of average-risk begin screening at age 45. Patients with IBD or those with personal or family history of colorectal cancers should be screened based on their individual risk factors. Finding precancerous polyps and removing them during a colonoscopy is the single best method to prevent colon cancer. Studies confirm that screenings save lives, including this recent study that shows a 61% reduction in risk of death due to colon cancer in patients receiving colonoscopies at the prescribed intervals. Because of statistics like these, many public health officials advocate for colonoscopies over other forms of testing.

How Effective Are At-Home Tests?


In a study with almost 10,000 participants, Cologuard was compared with an immunochemical Fecal Occult Blood Test (FIT) and a colonoscopy as confirmation. The sensitivity for detecting colorectal cancer was 92.3% with Cologuard DNA testing and 73.8% with FIT. For precancerous polyps, the results were not as good. The sensitivity for detecting advanced precancerous lesions was 42.4% with DNA testing and 23.8% with FIT. Because of the test’s low sensitivity to precancerous lesions, it is recommended that the test is repeated every three years. In other words, repeated testing is recommended so when precancerous polyps become malignant, the test will catch it. The physicians at AIDH prefer to find and remove polyps before they become cancerous.

A Colonoscopy To Confirm


When there is a positive finding reported by FIT or Cologuard DNA test, the patient is then referred to a gastroenterologist for a colonoscopy. Also, patients at high risk are not eligible for the at-home tests and should rely only on a colonoscopy. Another group advised to skip at-home testing are those who are resistant to the idea of a colonoscopy as a follow-up on a positive result.

Sadly, a recent report from a large healthcare system in Texas followed 94 patients who had a positive FIT result and were referred to a gastroenterologist for follow-up. Seventy-four percent saw a gastroenterologist within a year and were offered a colonoscopy. Of the 94 patients, 32 did not follow-up with the test and it was noted that 18 of the 32 had no adequate reason for the refusal. They just didn’t want to have a colonoscopy.

What Would You Do To Save Your Life?


Despite the best efforts of GI specialists around the world, some people simply refuse to have a potentially life-saving colonoscopy. They feel too squeamish about the process, or they have heard horror stories about the preparation. Many Americans have been taught that it is not polite to talk about bowel movements. Breaking through that stumbling block can be difficult, but it is essential.

The truth is that preps have come a long way and are much more easily tolerated by most patients. The test itself is done with the utmost respect for patient privacy and dignity by the dedicated team of professionals at AIDH.

Summary 


Colonoscopy is the gold standard screening test for colon cancer. It really is that simple. Why risk your health on less effective tests that may require you to have a colonoscopy anyway? Since the update in screening guidelines has only recently changed, all patients should check with their individual providers for coverage benefits, but most insurance policies cover the full cost of an initial screening colonoscopy starting at age 50. It is important to note if an at-home test is positive and the patient is referred for a colonoscopy, the insurance classification changes from screening to diagnostic. Diagnostic colonoscopies are covered differently, requiring deductibles, co-pays, or percentages as outlined in individual policies. If you are at least 45 years of age with no elevated risk factors, it is time to make an appointment with a physician at Associates in Digestive Health for a screening colonoscopy.