Ok, it’s time. You’re 50 years old. You have been urged, prodded, persuaded, bullied, and begged, and you have agreed to colon cancer screening. Now, what are your options? Do you really have to have a colonoscopy?
It depends.
First, make no mistake about it. A colonoscopy is the gold standard (meaning, the best) method of screening for colon cancer. Not only is it the least likely to miss a cancer, it offers the longest recommended time between screening methods. If you have no polyps and no close family history of colon cancer, it’s 10 years before you have to undergo another screening.
If you cannot or will not undergo a colonoscopy, another option is a compute tomography (CT) colonography (or virtual colonoscopy). This method uses low dose radiation to visualize along the length of your colon for any polyps. Although it doesn’t require sedation and is as accurate as a colonoscopy at identifying polyps, if a concerning polyp is found, you then must undergo a regular colonoscopy to biopsy it. If a CT colonography alone is done the cost savings is 50%, but if a CT colonography must be followed by a colonoscopy, the cost increase over a standalone colonoscopy is 150%. This tremendously adds to the overall cost of what is sometimes not a very well covered test (CT colonography) by some insurances. Also, both tests require the same bowel preparation procedure. Furthermore, the CT colonography has a window of only five years to the next screening.
Another screening option is flexible sigmoidoscopy or air contract barium enema. One test is a mini colonoscopy done directly in the doctor’s office without benefit of anesthesia (though you still must do the prep.) Although less expensive, this test is rarely done anymore and only buys you three-five years before the next recommended screening since the test only visualizes the last part of the colon. Air contract barium enema is also rare due to limitations of the number of cancers it finds.
A less invasive test that can be done on people with very low risk levels for colon cancer is Cologuard® or FIT-DNA testing. These are two tests that look for traces of DNA associated with colon cancer. A negative test result is good for three years but only picks up 70-92% of colon cancers and only 40% of precancerous polyps. The low capture rate means a cancer could be missed, but it’s certainly better than not getting screened at all. Cologuard and Fit-DNA cost about half what a screening colonoscopy costs but a positive test will still mean that a colonoscopy needs to be done. These stool tests are usually well-covered by insurance companies.
The final method of colon cancer screening is a yearly test for fecal occult blood (looking for hidden traces of blood in the stool) either at your doctor’s office or with stool testing cards that the office sends home with you. This method is extremely inexpensive, but misses a lot of polyps and early cancers. It is better than nothing, but not ideal.
Regardless of how you decide to get screened, just do it; don’t let these reasons keep you from being proactive. Your colon will thank you.
Dr. Beth Hodges is a family practice and palliative care/hospice physician in Asheboro, N.C., as well as a part-time medical director for HealthTeam Advantage.
