There are Alternatives (and I did one)
Colonoscopies are potentially life-saving, and colorectal cancer is the second leading cause of U.S. cancer deaths (after lung cancer) that affect both men and women. More than 50,000 people die each year from colorectal cancer in the United States, even though it tends to be slow-growing and treatable.
About 35% of Americans who should be screened have not – that’s about 23 million people! In addition, of those who get colonoscopies, only about half do so according to recommended screening guidelines. The American Cancer Society suggests screening starting at age 50, or younger if there is a family history of colorectal cancer or other risk factors, such as a history of ulcerative colitis or Crohn’s disease. Colonoscopies catch about 90% of colorectal cancers.
People offer lots of reasons for not having a colonoscopy, saying they:
- Are fearful – of the results, the procedure, and the prep
- Have no insurance coverage or inadequate insurance coverage
- Are “squeamish”
- Have to take a day off work for the procedure
- Don’t have the time
- Need someone to drive them home after the procedure
- Heard of someone who had problems (such as a perforated colon) from the procedure
No matter how good a screening test is, it’s no good if people don’t do it! There are alternatives to a colonoscopy, including fecal-testing for blood such as FIT (fecal immunochemical test) or FOBT (fecal occult blood test); virtual colonoscopies, which use X-rays and computer imaging to get 2-D and 3-D pictures of the rectum and colon; sigmoidoscopy, a thin, flexible tube which examines the rectum and portions of the large intestine closest to the rectum, and the newest one that I did, Cologuard. Note that if results from these alternative tests are suspicious, you’ll still need a regular colonoscopy for follow up.
My (Excellent) Experience with Cologuard
I had a regular colonoscopy at age 50: hated the prep, but found the procedure itself okay, and received a clean bill of health. Fast-forward a dozen years (yes, I should have done something at 60, but procrastinated), because I didn’t have polyps or any conditions/illnesses associated with colorectal cancer, nor do I have a history of colorectal cancer in my family, it put me at “average” risk for colorectal cancer, and my doctor said I’d be a good candidate for the newest alternative to a colonoscopy, Cologuard, approved by the FDA in August 2014. Cologuard was developed by Exact Sciences and researchers at the Mayo Foundation for Medical Education and Research, and involved a clinical study of 10,000 patients. It involves procuring a stool sample at home, and mailing it to the Exact Sciences lab to test the stool for blood and abnormal DNA that could be caused by cancerous or pre-cancerous cells.
As with any test, including a colonoscopy, there can be false positives (results indicating you have a problem when you don’t), and false negatives (results indicating you don’t an issue but you really do). Cologuard has a 90% accuracy rate for finding colorectal cancer, similar to a colonoscopy.
Why I Liked It
Cologuard is seductive because it’s easy to use, you collect your sample at home, and there is no prep, no fasting, and no dietary restrictions. You do need a doctor’s prescription for Cologuard. Once you send Exact Sciences your prescription, your insurance information, and fill out some minor paperwork (name, age, address, etc.), Exact Sciences sends you everything you need, via UPS, to properly collect your fecal sample, along with the box and label to return it (I did have to drive to a UPS store to send my sample to them). Exact Sciences includes a booklet with complete directions (including pictures!), they call you to go over everything, and are available for any questions.
If you’re on traditional Medicare, Cologuard is fully covered. Many insurance companies also cover the procedure.
What’s Not So Great
Unfortunately, my insurance company does not presently cover Cologuard. So, it’s important to find out if you’re covered prior to going down the Cologuard path. If it’s self-pay, the most you’ll have to fork over is $649, although Exact Sciences will first seek payment from your insurance provider on your behalf, and may file several appeals if denied. (I’m in the middle of this process, but am willing to pay the $649 if necessary.)
You can also fill out a form from Cologuard requesting that you also receive a copy of your results, rather than having to make an appointment with the doctor to find out. I figured if it’s negative, I’m done.
With a regular colonoscopy, if there are no polyps or anything amiss, you don’t have to go back for ten years. With Cologuard, the guidelines are every three years, assuming your stool analysis is “negative.”
What’s the “Yuck” Factor?
Okay, I’m not a squeamish person. My first career, years ago, was teaching Biology, so I’ve done numerous dissections and have pithed (don’t ask if you don’t know) frogs, have held intestines, hearts, and lungs, etc. I have three children, so have cleaned up lots of diarrhea, vomit, and my two (now strapping adult) sons have peed in my face while changing their diapers on a few occasions. But, I will admit I was a little nervous about collecting the fecal sample.
I’m very happy to say that the “yuck factor” is extremely low. You only have to place a bracket with a container (everything is in the box from Exact Sciences) across the toilet seat to catch the sample. Then, pour some liquid on it to “preserve” the sample, and screw on the lid. Prior to screwing on the lid, you also need to scrape the surface of your sample with a long “probe” and screw the probe into a tube. That’s it. Easy, and you never touch anything you wouldn’t want to touch!
Bottom (No Pun Intended) Line
The entire process, from ordering the test, to faxing the info, to receiving the results took about six weeks. Happy to say, everything came back “negative.” Would I do it again in three years? Definitely. In three years, I’ll be 65, and Cologuard is fully covered by Medicare! Even if I wasn’t covered, I’d consider Cologuard again. And, I don’t get any kick-back nor am I associated in any way with Cologuard. Just sayin’ and just sharin’.
Previously published in the Summer 2016 Issue.