Colonoscopy screenings provide an opportunity to look for any signs of colorectal cancer, bowel diseases, polyps and other conditions that can affect overall gastrointestinal health. Learn more about when you should be screened.
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?
If you experience any stomach discomfort, bleeding in your stool or sudden weight loss at any age, contact your physician as soon as possible.
People should also 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. You should demand a proper diagnosis and quality of care from your physician – your life could depend on it.
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.
If you can not afford a colonoscopy (the gold standard for screening) or a barium enema combined with a sigmoidoscopy (almost as effective), contact us for information on how we can help.
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.
Colonoscopy Coverage Under the Affordable Care Act
The Affordable Care Act requires health plans that started on or after Sept. 23, 2010 to cover colorectal cancer screening tests, which includes a range of test options. In most cases there should be no out-of-pocket costs for these tests, such as co-pays or deductibles.
Although many private insurance plans cover the costs for colonoscopy as a screening test, you still might be charged for some services. Patients should check with their health insurance provider to determine their colorectal cancer screening coverage, including if our doctor is on your insurance company’s list of “in-network” providers. If our doctor is not in your plan’s network, you may have to pay more out-of-pocket. Call your insurer if there’s anything you’re not sure about.
Soon after the ACA became law, some insurance companies considered a colonoscopy to no longer be just a “screening” test if a polyp was removed during the procedure. It would then be a “diagnostic” test, and would therefore be subject to co-pays and deductibles. However, the U.S. Department of Health and Human Services has clarified that removal of a polyp is an integral part of a screening colonoscopy, and therefore patients with private insurance should not have to pay out-of-pocket for it.
- Once every two to five years for those at high risk, depending on clinical finding (regardless of age)
- Once every 10 years for those who are at average risk
- Four years after a flexible sigmoidoscopy for those who are at average risk
If you have questions about your costs, including deductibles or co-pays, it’s best to speak with your insurance provider.
It’s important to understand that if you have a screening test other than colonoscopy and the result is positive (abnormal), you will need to have a colonoscopy. This is typically considered a diagnostic colonoscopy– not screening – so you may have to pay the usual deductible and co-pay.
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 five-year survival rate for colorectal cancer when diagnosed at an early stage before it has spread is about 90%.
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.
- Biopsy: The removal of cells or tissues so they can be viewed under a microscope to check for signs of cancer.
- 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.
- 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.
- 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.
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