a predictable passage in life: Hit 50, get lots birthday cards
with old-age jokes, a mailbox full of AARP solicitations —
and a colonoscopy.
millions of Americans — about one-third of those in the
recommended age range for colon cancer screening — haven’t
been tested. Some avoid it because they are squeamish about
the procedure, or worried about the rare, but potentially
serious, complications that can occur as a result of it.
influential panel has added some new choices, aiming to get
more Americans screened for colorectal cancer, which is the
second leading cause of cancer death in the U.S.
five things you need to know:
Getting tested — in any of a variety of ways — is a good
its review of all the available medical evidence, the U.S.
Preventive Services Task Force — an independent blue-ribbon
panel of medical experts — updated its colorectal cancer
screening guidelines last week. The panel gave an
"A" rating to screening all adults between ages 50
to 75 years at average risk of the disease, saying the
benefits are "substantial." People with a family
history or other risk factors might want to start earlier —
and those older than 75 should talk with their doctors about
whether to continue screening.
that not enough Americans are getting screened, the panel
essentially said the best test is the one that patients will
take: "The goal is to maximize the total number of
persons who are screened because that will have the largest
effect on reducing colorectal cancer deaths."
less-invasive tests may qualify for free preventive screening.
biggest change from prior guidelines is the panel’s
inclusion of two more ways to screen for the disease,
including "virtual colonoscopies," like President
Barack Obama underwent in 2010. Also called computed
tomography (CT) colonography, the test uses special X-ray
machines to examine the colon. The panel also added a $650
home test called Cologuard, which checks stool for elevated
levels of altered DNA that could indicate cancer. Those tests
join several others that were part of the panel’s previous
recommendations: the full colon exam called colonoscopy;
sigmoidoscopy, which uses a lighted tube and camera to examine
just the lower portion of the colon; and two other types of
home stool tests, fecal occult-blood tests (gFOBT) and fecal
immunochemical tests (FIT). Because of the task force’s
"A" rating for colon cancer preventive screening
these tests generally must be offered to insured patients
without a copayment or deductible under the rules put in place
by the Affordable Care Act.
expect all insurers to drop co-pays on the new tests right
Medicare already covers Cologuard as a preventive screening
tool, many private insurers do not. Of people with private
insurance who are in the target age range, about one in four
currently have coverage for the test, said Kevin Conroy,
president and CEO of Exact Sciences, which makes the test.
"That’s going to change," he said, "because
health plans have told us that they will follow the task force’s
comes to virtual colonoscopies, some insurers — including
Cigna — cover them, but Medicare does not. In 2009, Medicare
said there was insufficient medical evidence to determine if
such tests should be covered nationally.
Medicare will likely be asked by proponents of virtual
colonoscopy to revisit that decision.
the ACA, insurers have up to a year to incorporate
"A"- or "B"-rated screening tests into
their benefit packages without a copayment. Many experts
believe insurers must offer all the types of tests, although
they do not have to cover each manufacturer’s product if
several competitors exist in a category.
task force didn’t pick favorites.
panel did not rank the tests, noting a lack of head-to-head
comparisons showing any one method has the most net benefit.
All tests have pros and cons. For example, getting a
colonoscopy every 10 years has the advantage that, if
potentially cancerous polyps are detected, they can be removed
during the procedure. But it also carries a small risk of
harmful complications, such as anesthesia-related cardiac
problems, bowel perforations or abdominal pain. Sigmoidoscopy
at 5-year intervals has a lower rate of complications, but can
miss some cancers because it doesn’t reach the entire colon.
Annual stool tests, which don’t themselves carry any risk,
reduce colorectal cancer deaths, the panel noted. The newer
FIT immunochemical stool tests are a bit better at spotting
cancers than FOBT, which studies show can correctly identify
cancers 62 percent to 79 percent of the time. Cologuard —
recommended every one to three years — detects existing
cancers 92 percent of the time, but has a higher
false-positive rate than FIT. Virtual colonoscopies, which
expose patients to X-ray radiation, spot existing cancers of
10 millimeters or larger 67 percent to 94 percent of the time.
The exam can also lead to additional, sometimes unnecessary
testing because it flags potential problems outside the colon
40 percent to 70 percent of the time, with only about 3
percent of those concerns ultimately needing some form of
treatment, the panel noted.
might still get hit with a copayment.
preventive screening is covered without copayments or
deductibles, some patients still end up with a bill. Medicare,
most notably, requires a 20 percent copayment if a polyp is
found during a screening colonoscopy and removed. That payment
averages $272, although advocates say they have seen far
higher bills. Most private insurers do not charge patients if
a polyp is found during a preventive screening, following
Obama administration clarifications on the topic.
bills in Congress aim to apply those same rules to Medicare.
way consumers can get hit with a copayment is if a stool test,
sigmoidoscopy or other exam indicates cancer might exist. A
colonoscopy is then performed and some insurers consider that
test a "diagnostic" exam, rather than a preventive
screening. The American Cancer Society Cancer Action Network
says it has asked the administration to clarify what happens
in such a case. "If a patient has a positive test, the
next step is colonoscopy, and therefore should be covered
without cost-sharing," said Caroline Powers, director of
federal relations with ACSCAN. "We’re trying to get
more people screened."