What You Should Know about Colorectal Cancer Screening

The American Cancer Society recently changed the recommended starting age for colorectal cancer screening for adults to 45, which is earlier than the previously recommended range of 50 and 75.

Many patients are nervous about getting screened about colorectal cancer and might hesitate to make an appointment. They may be reassured to hear, however, that there are now many ways to screen for colorectal cancer and that advancements have made colorectal cancer screening tests as comfortable as possible.

A colorectal cancer screening will assess whether you're at risk for, or have, colon or rectal cancer. According to the U.S. Centers for Disease Control and Prevention (CDC), a colorectal cancer screening test looks for disease in those without symptoms. If you are already at risk, doctors use a colorectal cancer diagnostic test.

A colonoscopy is the gold standard for diagnosing colon cancer. Less-invasive stool tests can also evaluate cells in your colon to see if they indicate disease.

Finding Colorectal Cancer

The concept behind screening is to spot any disease early so you can receive treatment right away. Getting screened reduces your risk of colorectal cancer, the CDC reports.

Colorectal cancer typically begins with precancerous polyps, which are abnormal growths in the colon or rectum. A colonoscopy can spot and remove polyps, as well as detect cancer. Stool tests can identify DNA or other genetic changes that may indicate colorectal cancer or a precancerous condition.

Tests to Screen for Colorectal Cancer

Your doctor can tell you which screening method is best for you, based on your personal medical profile and history.

Colonoscopy

Before undergoing this procedure, you must prepare your body by ingesting a substance to clear your bowels, after which you need to refrain from eating. During the procedure, a doctor inserts a tube into the anus and views the entire colon and rectum. If the doctor finds a polyp, he or she can remove it right away and send it for a biopsy to detect cancer. Most people only need a colonoscopy every 10 years unless they're in a high-risk group, according to the US Preventative Services Task Force (USPSTF).

CT Colonography

Also known as virtual colonoscopy, this procedure uses X-rays and computers to take images of your colon and rectum.

FIT and Other Stool Tests

Following are a few types of stool tests:

• A stool DNA test. Cologuard is the only at-home DNA test currently available in the U.S. This test should be done every 1-3 years, according to the USPSTF recommendations.  If the test produces any flags, your doctor may send you for a colonoscopy.
• IT and gFOBT tests. The guaiac-based fecal occult blood test (gFOBT) and fecal immunochemical test (FIT) both look for and examine blood in the stool.

Stool tests may be as effective at saving lives as a colonoscopy, Dr. Alex Krist, chairman of USPSTF noted recently.

Flexible Sigmoidoscopy

This procedure consists of the doctor inserting a lighted tube into your rectum to check for colorectal polyps in the rectum and lower colon. If your doctor recommends this method, it needs to be done every 5 years (or every 10 years if you have a yearly FIT test).

Double-Contrast Barium Enema

You don't have to be sedated for this procedure, during which air and barium are put into your rectum to provide a look at the colon using X-rays.

Screening and Colorectal Cancer Risk

The USPSTF currently recommends colon cancer screenings up until the age of 75, but they may also be appropriate when you're older. If you are between 76 and 85, consult with our doctor about screening.

The USPSTF says doctors should not recommend screening if you are over the age of 85.

You may also require earlier screening if you are at high risk of colon cancer:

• You or a family member have had colorectal polyps or colorectal cancer.
• You have an inflammatory bowel disease such as ulcerative colitis or Crohn's disease.
• You have a genetic syndrome such as familial adenomatous polyposis (FAP), or hereditary non-polyposis colorectal cancer (Lynch syndrome).

The USPSTF recommends colonoscopy as the only test suitable for high-risk individuals.

Will Your Insurance Cover Screening for Colon Cancer?

Whether or not you're covered for colorectal cancer screening may depend on your health insurance policy, your risk factors, and the colorectal testing you have undergone to date.

It may also depend on whether the procedure is a screening or diagnostic test. If you're at high risk, the test will likely be diagnostic, and your insurance may not completely cover it.

If you're not considered high risk, insurers may fully cover a colonoscopy to screen for colon cancer as long as it meets USPSTF recommendations. If during such a screening procedure, your doctor find and removes a polyp, the test should still be covered if it was initially labeled as a screening procedure.

However, if your doctor finds something concerning during a screening test, they may then classify you as high risk. That may mean that subsequent tests may be labeled as diagnostic tests and may not be completely covered.

What's the price tag? The CDC says the average clinical cost for a colonoscopy is $1,150, while FIT tests average $304. Cologuard reports that most people are covered — but check with your insurance to determine whether this is true for you.

Checking with your insurer before booking any appointment for colorectal cancer screening is a good idea for anyone and any test.

You'll find out how the insurance plan is classifying the recommended test (whether it's as a screening or diagnostic test), and if you will receive full, partial, or no coverage.

We understand that colorectal cancer screening brings a lot of questions. Take comfort in knowing that there are many options available to you, and it’s important to speak with your provider about any concerns or reservations you might have. They will be able to work with you to make screening as comfortable and easy as possible.