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The Bottom Line
Can mail-in colorectal cancer tests match traditional colonoscopy? Local experts weigh in.


By LAUREN SIEBEN

March 2019



Here’s what you might think you know about a colonoscopy. One, it requires a full day spent starving while chugging gallons of vile tasting laxative and camping out in the bathroom. And two, a camera … you know, there.

Now here are the things you should know about colonoscopy. Though it is the No. 2 cause of cancer-related deaths in the U.S., the colorectal cancer that the procedure detects is also highly preventable.  And — despite what your neighbor, your brother or that overly dramatic coworker told you — today’s lower volume prep regimens and twilight sedation make the process safe, painless and far less inconvenient. Plus, many insurance plans will cover the process in full as a screening benefit, and a clean bill of colon health generally buys you a full decade until your next test.

Still not convinced? You’re not alone.

“Despite the benefits of colon cancer screening, only 60 percent of at-risk people undergo screening,” says Dr. Aaron Baltz, board-certified physician in gastroenterology and internal medicine at Ascension Wisconsin. Baltz says that average-risk patients should begin screening at age 50, while people with a family history of colon cancer or advanced polyps; a personal history of colon cancer or polyps, abdominal radiation, Crohn’s disease or ulcerative colitis; or symptoms such rectal bleeding, abdominal pain, a change in bowel habits and unexplained weight loss should seek the advice of their physician about starting sooner.

“Many patients ask why we perform colonoscopies when people do not have symptoms,” says Dr. Erica Samuel of GI Associates. “We do this because small polyps do not cause symptoms. Once the polyps are large, cancerous and symptomatic, the cancer may be advanced, and cure is unlikely.”

Baltz says that choosing a quality endoscopist helps ensure a higher polyp detection rate and a lower complication rate. “While the risks are low, the more common complications are bleeding [when a polyp is removed], perforation or an issue with the sedation,” he says. “Studies on the risk of perforation estimate the risk at less than 1 in 1,000 colonoscopies nationwide.”

And about that storied bowel prep regimen to ensure the pristinely clean colon that affords optimal test results? If you can get two large-sized fast-food drinks down over the course of several hours, you’ll do just fine.

“Patients typically start the night before, after returning home from their normal daily activities,” says Samuel. “The prep drink is better tasting and a lower volume than ever before — 64 ounces broken down into two 32-ounce drinks. In fact, most patients can use the MiraLax prep, which is a tasteless medicated powder mixed into a sports drink of their choice.” You can add in Jell-O, popsicles and chicken broth to ward off any hunger pangs, adds Baltz.

So what about those TV ads in which a cheery little animated box encourages you to, er, go postal with your cancer screening instead? As appealing an alternative as the at-home, mail-in test might seem — well, other than packaging up your own fecal matter and heading for the post office — both Baltz and Samuel say that these testing products are significantly limited in their ability to detect the slow-growing polyps that can signal the onset of cancer. Polyps that can be safely and easily removed during the colonoscopy process, eliminating their ability to become cancerous.

“I tend to see a lot of dissatisfaction in my patients who have done the Cologuard test,” Samuel says. “It is a combination of two tests — a test for DNA found in cancer and advanced polyps and a test for blood in the stool — and, unfortunately, if the results come back positive, you are not told which part of the test was positive. This leads to an unreasonably high false-positive rate, which is understandably stressful for patients who may be under the impression that a positive test means they have colon cancer.”

Atop that, most insurance companies consider Cologuard and other mail-in tests a screening procedure, so if a patient tests positive, the traditional colonoscopy recommended next will not be covered as a screening benefit.

“Insurance companies benefit in this situation, as they provided coverage for the Cologuard test, which is only a few hundred dollars,” Samuel explains. “If the patient had opted for the traditional colonoscopy to begin with, the insurance company would be responsible for the cost of the colonoscopy, which is significantly higher. Insurance companies are not always forthcoming about this.”

The bottom line: choosing a screening test for colon cancer is an individual decision and should be discussed with your trusted medical provider. But, both doctors agree, any screening test is better than no test at all.






 

This story ran in the March 2019 issue of: