Beyond Awareness: How to Determine What Colorectal Cancer Screening Test is Right for You

March is Colorectal Cancer Awareness month and it is recommended that all people over the age of 50 be screened.  According to the Centers for Disease Control and Prevention, “Among cancers that affect both men and women, colorectal cancer is the second leading cause of cancer deaths in the United States. Every year, about 140,000 Americans are diagnosed with colorectal cancer, and more than 50,000 people die from it.”

The good news is screening is the number one way you can reduce your risk of colon cancer. Despite its high incidence, colon cancer is unique in that it is one of the most preventable and, if found early, most treatable forms of cancer.

Screening is a way that a healthcare provider can look for evidence of cancer before there are any symptoms of the disease.  The American Cancer Society reports due to improved awareness of and screening for colorectal cancer in the general population, that the rates of death from advanced colorectal cancer have been rapidly declining.   Unfortunately, they believe that many patients are not receiving appropriate screening due to lack of patient, as well as provider, education on the availability, costs, risks and benefits of the different options.  Because of this, we at Kura MD, are providing this short overview of the options for Colorectal Cancer Screening.

Colonoscopy has long been considered the gold-standard in screening for CRC.  Colonoscopy requires that a long, thin, flexible tube with a camera on the end be inserted through the anus for evaluation of the entire rectum and colon for polyps and/or cancer.  When a suspicious lesion is found, it can be removed and sent to pathology to determine whether or not it is cancer.  There are, however, certain drawbacks to colonoscopy for colorectal cancer screening that prevent many patients from completing the test as recommended.   The first of these is that for the test to be done, the patient must first complete a bowel prep that will clean stool out of the colon.  Patients may not fully complete the bowel prep due to discomfort and that can result in a poor quality test.  Secondly, this procedure requires sedation, and that means after you will be unable to drive home.  Many patients may not be able to schedule the procedure because sedation is required they may not have a ride, and some patients find that they do not tolerate sedation due to side effects.  Finally, there is a small risk of injury to the colon associated with this test.   Many patients, especially those at low risk for CRC, may not comply with this method of screening due to the perceived and actual inconvenience associated with the test, or they may have had one and then fail to repeat the test at the recommended intervals.

For this reason, other methods of imaging the colon have been introduced that utilize x-rays or CT rather than video.   These tests use barium and/or air held within the colon to show contrast between the wall of the colon and the empty space inside, which can show any irregularities that might indicate a polyp or colorectal cancer. However, it is important to know that these screening tests still require a bowel prep to clean the colon prior to imaging, and many patients find the discomfort of holding the contrast material within the colon during the test to be significant.   In addition, if any irregularities are found, a colonoscopy will be required to remove the polyp or tumor.

Because of the risks and discomfort associated with imaging the colon with either colonoscopy, x-ray, or CT, many providers and patients prefer to test the stool for signs of possible colorectal cancer in patients who are considered low or average risk for CRC.   The primary stool test that has been used for many years is screening only for the presence of blood in the stool, and is called a FIT test.   This test has been the most commonly used for many years until the recent introduction of Cologuard®, which tests for the presence of blood as well as DNA in the stool that may indicate the presence or a polyp or cancer.   Because a FIT test only tests for blood, it will miss most early stage polyps and some cancers.   The Cologuard® test is more sensitive because it also tests for abnormal DNA within the stool.   If any abnormalities are found on either test, a colonoscopy will be required.

In the past, one major drawback of the Cologuard® test for screening was that many insurance companies, with the exception of Medicare, did not cover the test, resulting in an out of pocket cost to the patient.   In the past few months the test has received its rating from the Healthcare Effectiveness Data and Information Set, otherwise known as a HEDIS score.   Based on the test’s effectiveness at screening for CRC in a low risk population the HEDIS score will encourage insurance companies to offer coverage for the test to provide the most complete and cost-effective services to the insured patients.

Finally, only a physician can decide which method of CRC screening is appropriate based on your risk factors and past medical history.  Many physicians may not be well educated on the options for screening or may have biases for or against certain screening tests.   Kura MD has non-biased physicians available for consultation 24/7, who can help you to calculate your risk and recommend appropriate screening tests for CRC screening, including Cologuard®.  Exact Sciences will also work directly with you to obtain coverage for the Cologuard® test, if both you and the physician agree it is your best option.

This March make sure you talk to a doctor about Colorectal Cancer Screening. It might save your life, or the life of someone you know.

Find more information on Colorectal Cancer at https://www.cancer.org/cancer/colon-rectal-cancer/early-detection.html

More information on Cologuard® is available at http://www.cologuardtest.com/how-to-talk-to-your-doctor/discussion-guide?gclid=CIah8vWajtICFUlNfgodXR4J5g