AS I SEE IT
Trends in Colorectal Cancer Screening BY CINDY YOUNG, RN, CASC
Colorectal cancer, a highly preventable and treatable disease, causes the second highest number of cancer deaths in the US, accord-
ing to the American Cancer Society. Colonoscopies can detect colorec- tal cancer in its early stages and pre- vent it from spreading. Unlike colo- noscopy, other screening options in the market allow patients to avoid going to a healthcare facility for test- ing. For example, the Cologuard test allows patients to collect a stool sam- ple at home and mail it to the lab in a pre-labeled box. Patients who are wary of the prep for and the invasive nature of colonoscopies often choose Cologuard, which detects colorec- tal neoplasia associated DNA mark- ers and occult hemoglobin in human stool. This test, however, comes with a potential problem. A patient with hemorrhoids might send a bloody sample and Cologuard would screen the sample positively for colorectal cancer. The patient would then have to go in for a colonoscopy to con- firm the screening and face insur- ance implications. We do see patients coming into our facility for a colo- noscopy because of a positive Colo- guard test.
Insurance covers Cologuard for colorectal cancer screening, but when a patient has to follow up the Cologuard test with a diagnostic colonoscopy, the screening colonos- copy gets coded as diagnostic. This leaves patients with higher out-of- pocket costs than if they were to have the traditional screening colo- noscopy in the first place.
The Cologuard test is not 100 per- cent accurate. According to the Gas- troenterology Consultants of San
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Antonio website, Cologuard can detect 92 percent of cancers but only 42 percent of large precancerous pol- yps. Cologuard is better at detecting cancer than the fecal immunochemi- cal test (FIT)—92 percent versus 70 percent for FIT—but the false posi-
ASC FOCUS SEPTEMBER 2020 |
ascfocus.org
tive rate is higher. Cologuard has a 12 percent false positive rate and that rate increases as people age, accord- ing to the company’s website. Our Surgery Center of Farming-
ton offers colonoscopy screening with two options that help patients
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