If you are between the ages of 45 and 85, you should have a colorectal cancer screening routine, according to the American Cancer Society (ACS). But a colonoscopy, in which your doctor uses a special camera to look inside your colon and rectum looking for abnormal growths called polyps, isn’t the only option for taking charge of your gastrointestinal health.
You can choose from non-invasive screening methods: computed tomography (CT), colonography and/or a stool test. Billionaire entrepreneur and Shark cage investor Mark Cuban says Fortune he enjoys the relatively low cost and simplicity of the former, also called virtual colonoscopy. In short, it is an X-ray examination that does not require sedation or anesthesia.
“I like getting CT versions because while they are not cheap, the cash price is much cheaper than the cash price of a traditional colonoscopy,” Cuban says via email, “which allows me to get one every few years and the traditional every seven years. ”
Cuban says the cash price for his most recent virtual colonoscopy was less than $600. Procedural costs may vary per location. For example, in New York City zip code 10038, where Fortune is located, a virtual colonoscopy with contrast ranges from $496 to $2,613 with a fair price of $778, according to Healthcare Bluebook. A traditional colonoscopy ranges from $997 – $10,541 with a fair price of $2,712.
Because the U.S. Preventive Services Task Force (USPSTF) recommends colorectal cancer screenings starting at age 45 for people at average risk for developing the disease, federal law requires Medicare and private health insurers to cover the costs. This means patients don’t have to navigate copays or deductibles. However, the ACS notes that the definition of a “screening” versus a “diagnostic” test may vary by insurer, and not all plans cover all forms of colorectal cancer screening.
In addition, people at high risk for developing colorectal cancer may need earlier and more frequent screenings. Talk to your doctor about which test is right for you and your insurer about how to get it covered.
Dr. Arthur Winer, a gastrointestinal medical oncologist at the Inova Schar Cancer Institute in Fairfax, Virginia, and Dr. Derek Ebner, a gastroenterology and hepatology neoplasia fellow at the Mayo Clinic in Rochester, Minnesota, explains your options for noninvasive colorectal cancer screenings below.
What is a virtual colonoscopy?
While traditional colonoscopy involves passing a camera called a colonoscope through your colon and rectum, the virtual option involves X-rays and a computer that creates 3D images of these organs. However, neither test can be performed if stool is in the way.
“The initial preparation is the same,” says Winer Fortune. “You still need to clean out the colon so you don’t have to avoid taking a bunch of laxatives and having to run to the bathroom.”
You should also drink a contrast agent the night before the procedure. Yet a virtual colonoscopy only takes 10 to 15 minutes – the traditional method takes less than an hour – and because you are not sedated or sedated, you can drive yourself home or back to work and immediately resume your normal activities.
Although the CT colonography itself is non-invasive, your radiologist will typically insert a catheter into your rectum to inflate your colon with air or carbon dioxide.
“The colon – like any hollow space – if there is nothing inside it, it will collapse,” says Ebner. Fortune. “The radiologists have to use that air, that gas, to open the colon and then use the CT images to see whether there are polyps or abnormalities along the inside of the colon.”
Traditional colonoscopy is safe, with a low risk of the colonoscope puncturing a hole in your organs or causing an infection, says Winer; virtual colonoscopy further reduces that risk. The virtual option comes with a low radiation dose, similar to that of other medical imaging.
CT colonography may be suitable for people who are averse to an invasive colonoscopy or who have problems with anesthetics. The procedure “has reasonable accuracy in detecting colorectal cancer and adenomas (noncancerous tumors),” according to the USPSTF, and should be performed more frequently: every five years instead of 10 years. Traditional colonoscopy remains the more comprehensive approach; CT colonography cannot remove polyps and may miss those smaller than 10 millimeters.
“The advantage of a (traditional) colonoscopy is that it both diagnoses the problem and can potentially treat it at the same time,” says Winer, referring to the removal of polyps. “[Doctors] Thread a lasso around it and tie it off. And if they find a tumor, they will biopsy it and mark it with some ink to show other doctors where the tumor is in the colon.”
Sometimes during a traditional colonoscopy, the scope can’t reach all the way to the beginning of the colon, Ebner says. When this happens, your doctor may have you undergo a virtual colonoscopy to complete the screening.
Medicare does not cover CT colonography.
Barbara Haddock Taylor/Baltimore Sun/Tribune News Service via Getty Images
What is stool-based colorectal cancer screening?
For some people, a stool test may be more convenient.
“The poop-based tests will screen your poop for blood, or there are DNA tests that the specialized labs do that will look for changes in the DNA of the cells that are in your poop,” says Winer. Fortune. “As the poop moves through your colon, it can pick up cells from these precancerous or cancerous spots.”
The ACS recommends these options:
- Fecal immunochemical test (FIT): This type of screening is available without a prescription and looks for blood that may be hidden in the stool of your lower intestines.
- Guaiac-based fecal occult blood test (gFOBT): Your doctor can provide you with a kit that uses a chemical reaction to screen for hidden blood in your stool. This test limits your diet somewhat; For example, you are encouraged to avoid red meat for at least three days before testing.
- Multi-targeted stool DNA test with fecal immunochemical testing (MT-sDNA, sDNA-FIT or FIT-DNA): Cologuard, the only test available in the U.S., requires a prescription.
A disadvantage of stool tests, according to Ebner, is that they must be performed frequently: FIT and gFOBT annually, and Cologuard every three years. If these tests produce abnormal results, a diagnostic colonoscopy is needed. On the other hand, stool-based tests do not include bowel preparation.
Which colorectal cancer test is best?
“The best test is the one that is done,” says Ebner Fortune. “What’s really scary is that about a third of people are eligible for colorectal cancer screening [and] has not yet been screened.
“One of the benefits of having a lot of different options is that it then gives the person an opportunity to say, ‘Hey, you know what, this works best for me,’ especially now that we’ve lowered the age to 45.”
Winer reiterates: “In my opinion, as an oncologist, anything is better than nothing – all these tests. I think the worst thing anyone could do is not do any and just hope they don’t get colon cancer.”
For more information about colorectal cancer screening:
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