Colorectal Cancer Screening
Colon Cancer has been called the most fatal, yet the most preventable disease. For those uneasy with colorectal cancer screening, “colon cancer can kill you, embarassment will not,” says John Kisiel, MD, gastroenterologist at the Mayo Clinic.
Source: Who should be screened for colorectal cancer?
“Over the past decade, it’s estimated that screenings have reduced the risk of colon cancer by 77 percent. Unfortunately, it’s also estimated that 40 percent of at-risk persons have never been screened.”
Source: University of California at San Diego (2018)
“People say what you don’t know won’t kill you. What you don’t know will kill you. That’s the problem when it comes to your health,” says Orlena. “I went almost two years having issues and symptoms that literally could have killed me. A colonoscopy saved my life.”
Her colonoscopy found a huge tumor that hadn’t yet turned cancerous.
“You don’t want to find out you have a massive tumor and you didn’t do anything about it. And the only way you could do something about it is go get a colonoscopy? Go get a colonoscopy. It’s not that bad.”
A 5-minute video from Capital Digestive Care of the Washington DC area
"A Colonoscopy Saved My Life"
Drama about Regret Over Missed Colonoscopy
Eddie T regrets not insisting that his now-deceased best friend Archie get a colonoscopy which might have saved his life, in a dramatization.
“If anybody needed to get that colonoscopy, it was Archie. We all kept after him. I wish I’d have tied him up and dragged him. My best friend! I just miss him in so many ways. All gone now.”
“His stage 4 colon cancer could have have been caught and probably been cured all right at stage 1. A colonoscopy! Just a colonoscopy. Nobody likes them. But they save lives. And we Black folk really need to pay attention cause it’s killing more of us than anybody.”
A 16-minute video drama from the Baylor College of Medicine
Colorectal Cancer Screening
U.S. Preventive Services Task Force (2021)
The USPSTF recommends offering colorectal cancer screening starting at age 45 years.
The USPSTF recommends that clinicians selectively offer screening for colorectal cancer in adults aged 76 to 85 years. Evidence indicates that the net benefit of screening all persons in this age group is small.
In adults 86 years or older, evidence on benefits and harms of colorectal cancer screening is lacking, and competing causes of mortality likely preclude any survival benefit that would outweigh the harms of screening.
Source: U.S. Preventive Services. Colorectal Cancer: Screening (2021)
The U.S. Preventive Services Task Force is an independent, volunteer panel of national experts in disease prevention and evidence-based medicine who make evidence-based recommendations about clinical preventive services. Most private insurance plans are required to cover without a copay recommended preventive services that receive a grade of A or B from the Task Force.
National Compehensive Cancer Network (2021)
People at average risk should start screening at 45 years of age. Some people who have an increased or high risk of colorectal cancer should talk with their health care provider about whether to start screening before age 45.
Black individuals should begin earlier than age 45 if colorectal cancer runs in their family.
People in good health should undergo colorectal cancer screening up to age 75.
People between 76 and 85 should talk with their health care provide about the pros and cons of screening in light of their health. After 85, colorectal cancer screening is not needed.
Source: National Comprehensive Cancer Network: Colorectal Cancer Screening (2021)
U.S. Multi-Society Task Force of Colorectal Cancer (2021)
For average risk individuals: We suggest starting CRC screening at age 45 using either colonoscopy or fecal immunochemical test (FIT) as the primary screening modality.
African Americans should start screening at age 45.
For those with a family history of colorectal cancer: We recommend starting screening at age 40 in individuals with one or two first degree relatives with colorectal cancer or advanced colorectal polyps. If the first degree relative is younger than 60, or there are two or more first degree relatives with colorectal cancer or advanced colorectal polyps at any age, colonoscopy should be used, and screening repeated at five-year intervals. If the first degree relative is age 60 or older, any screening modality can be used and, if normal, follow average risk screening intervals. For individuals with history of only one second degree relative with colorectal cancer or advanced polyps, we suggest using average risk recommendations.
For individuals older than 75: The decision to screen should be individualized.
Source: American College of Gastroenterology Issues Updated Colorectal Cancer Screening Guidelines (2021) and ACG Clinical Guidelines: Colorectal Cancer Screening 2021.
Note: The U.S. Multi-Society Task Force of Colorectal Cancer represents the American College of Gastroenterology, the American Gastroenterological Association, and the American Society for Gastrointestinal Endoscopy.
American Cancer Society (2018)
Adults ages 45 and older should undergo regular screening with a high-sensitivity stool-based test or structural examination, such as a colonoscopy, depending on patient preference and test availability. Positive results from any non-colonoscopy test should be followed up with a timely colonoscopy.
American Cancer Society researchers found that blacks were 30% more likely than whites to be diagnosed with colorectal cancer after a negative colonoscopy but before the next recommended screening, and more often received colonoscopies from less-skilled physicians.
Source: American Cancer Society. Cancer Facts & Figures for African Americans 2019-2021. Atlanta: American Cancer Society, 2019
Details About the Three Main Screening Methods
FIT Home Screening Test
This is a colon cancer screening option that patients can perform from home, called the fecal immunochemical test (FIT).
This tests a small sample of the stool for human blood that cannot be seen with the naked eye. The sample is mailed to a lab and the results reported to your healthcare provider.
A 2-minute instructional video from UCLA Health.,
Colonoscopy
Darrell Gray, II, MD of The Ohio State University Wexner Medical Center shows what a colonoscopy sees as it snakes through the large intestine.
“We inspect carefully to look for polyps. Polyps are ingrowths of tissue that can occur within the colon and they can also be precancerous. If found, they would be removed at the time of the colonoscopy.”
A 4-minute video from the American College of Gastroenterology
Flexible Sigmoidoscopy
A Flexible Sigmoidoscopy only looks at the left side of the colon. It does not see the middle or the end of the colon as does a complete colonoscopy.
Sometimes this procedure can be done in the office without sedation. So it’s important for patients who are unable to receive sedation or to undergo a full colonoscopy that this is an accepted screening method.
A 3-minute video from the American Cancer Society.
Paying for your Colonoscopy
Under the Affordable Care Act, you can get certain preventive health care tests done for free. Colonoscopy is one of these tests. It is often free, but there are some cases in which patients must pay part of the cost. Congress recently passed a new law that will stop unexpected bills for screening colonoscopy gradually between 2022 and 2030, but for now this resource contains the most current information.
By answering a few questions, you can figure out what to expect to pay for your colonoscopy. Talk to your doctor’s billing team or your health plan if you have more questions.
See “Paying for your colonoscopy” from the American Gastroenterological
Association (AGA) .
Insurance Coverage of Colorectal Cancer Screening
Medicare
Medicare Covers FIT test at no cost for those age 50 or older; Flexible sigmoidoscopy at no cost when the test is done for screening; Colonoscopy at no cost when the test is done for screening. These tests are covered as long as the doctor accepts the amount Medicare pays as the full payment. If the test results in the biopsy or removal of a growth, it’s no longer a “screening” test, and there can be a co-insurance and/or a co-pay.
Private Health Insurance
Private insurance The Affordable Care Act (Obamacare) requires health plans that started on or after September 23, 2010 to cover colorectal cancer screening tests.
In most cases there should be no out-of-pocket costs, such as co-pays or deductibles.
Even if you have a “grandfathered plan,” it may still have coverage requirements from state laws, which vary, and other federal laws.
Medicaid
Medicaid Coverage for colorectal cancer screening varies by state.
Unlike Medicare, there’s no federal assurance that all state Medicaid programs must cover colorectal cancer screening in people without symptoms.
For more information, see “Insurance Coverage for Colorectal Cancer Screening” from the American Cancer Society (2021)
Rachel Issaka, MD
"I'm excited for Black people and other high-risk populations"
“The Affordable Care Act (Obamacare) states that anything graded A or B by the U.S. Preventive Services Task Force must be covered by insurers in the country,” says Rachel Issaka, MD, a gastroenterologist at the Fred Hutchinson Cancer Research Center in Seattle.
“So with age 45 becoming a grade B recommendation for when to begin screening, I’m excited for Black people and other high-risk populations who needed earlier screenings to have this important test covered.”
The Colonoscopies of Actor Will Smith and Journalist Nicholas St. Fleur
Will Smith Records His Colonoscopy and Is Surprised by What Was Found
Actor Will Smith, 50, recorded the story of his first colonoscopy in 2019 with the assistance of Ala Stanford, MD. Doctors removed one precancerous polyp from his large intestine.
“You had a polyp there,” Stanford tells Smith. “Had you not known, it continues to grow and grow. And in African American men in particular, the right colon is where cancers hide,” she says.
“When I decided I wanted to shoot this, it was much more this will be cool, this will be fun. I didn’t realize that there would be a precancerous polyp that would get found out of it,” Smith marveled.
An 18-minute video from Will Smith’s Youtube channel.
Chadwick Boseman's death made me realize I need to be screened"
“My mother had colon cancer at the age of 34, so I knew that I was at a higher risk to develop the disease myself,” says science journalist Nicholas St. Fleur.
“So once I saw that Chadwick Boseman passed away from colon cancer, it made me realize that I need to be more serious about getting checked myself.
I knew I had a family history, but I didn’t realize that, as a Black man, I was at higher risk as well.”
St. Fleur documented his screening from start to finish.
“I wanted to combat any stigmas associated with it because it is such a personal part of your body and it is something that many people don’t want to go through because they might find it scary.”
A 2-minute video from ABC News.
Watch the 5-minute documentary about his colonoscopy on the STAT website. Spoiler alert: St. Fleur is going to get screened again in 5 years.
"I Believe My Colonoscopy Saved My Life"
“My name is Yolanda and I’m 44 and I believe my colonoscopy saved my life. People that don’t think they need to be screened need to come talk to me.”
A 4-minute video from the NorthShore University HealthSystem in Chicago.
A Funny Reminder About a First Colonoscopy
“Some of your older friends might already be doing it. Your mother and I have done it and we’re happy to tell you all about it.”
A 1-minute video from the Centers for Disease Control and Prevention (CDC)