If you’re approaching 50, you’re facing issues unique to your next half century. Oh, sure, there are lots of good things to anticipate, like joining AARP for discounts on Depends or joining one of their affordable bus tours to the Dells. You can even fantasize about retirement, though it may be years and years away.
Other topics perhaps you’d just as soon not overthink: your mortality, for one. And perhaps budgeting a facelift, researching hormone replacement, scheduling mammograms, checking your IRA balance, wondering whether the Viagra sold online actually works, and, oh yes, your first colonoscopy.
With my own colonoscopy experience now behind me (so to speak), let me reassure colonoscopy virgins that the procedure is sort of anti-climactic, almost peaceful in its fashion. With 5.5 feet of fiberoptic tubing deep within my large intestine, I expected more drama. Among life’s experiences, I’d place the colonoscopy at easier than a root canal but more challenging than a paper cut or bad haircut.
But now you can draw a line through (rather than under) “get a colonoscopy” on your list of after-50 tasks.
Aren’t you glad you lived to see this day?
A couple weeks ago, the FDA approved a test called Cologuard, which uses DNA analysis of a stool specimen to screen you for colon cancer and pre-cancerous colon polyps. Moreover, because the test is quite a bit less expensive than a colonoscopy (in which both the gastroenterologist and the outpatient facility have to be paid), health insurance companies seem to be cooperating when it comes to paying for Cologuard.
The company that developed Cologuard, Exact Sciences, submitted data on 10,000 patients. When the test showed a diagnostic accuracy of 92% (about the same as a colonoscopy), the FDA was impressed.
If your Cologuard test result comes out positive, you’ll obviously need an eyes-on colonoscopy to locate and eventually remove any problem areas. If negative, repeat the Cologuard a decade later.
In rare cases, there are false-positive results (test is positive, follow-up colonoscopy is negative) as well as false-negatives (the test misses a cancer). Realize, though, that even a colonoscopy can miss a cancer. In this unnerving case, if you’re following the rules of getting an annual stool test for blood (part of a routine physical), any missed cancer will still be picked up early.
No more cherry-flavored laxative
Just think! With a Cologuard you’ll miss drinking that quart of cloying laxative that turns your intestines into Mount St. Helens until they’re clean enough to glow. You’ll also avoid the endless back-and-forth to your toilet and that ride to the hospital with your pelvic floor muscles locked tight (“Honey, please, do not hit another pothole!). You won’t have to watch your large intestine being explored up there on the monitor, and you’ll miss the cheery, “You’re fine, no cancer,” from your gastroenterologist. Finally, you’ll sidestep the experience of passing more post-colonoscopy gas than you knew any human could hold.
The test was devised for people over 50 at average risk. There are a few people for whom the Cologuard test is not advised, primarily those with a greater-than-average risk for developing colon cancer. These include patients with inflammatory bowel disease (ulcerative colitis and Crohn’s), previous colon cancers, and certain genetic susceptibilities to colon cancer. You also cannot have had recent large-intestine issues like diarrhea or rectal bleeding (hemorrhoids, fissures). Menstruating women should do the test between periods, since a little menstrual blood inadvertently mixed with stool can lead to a false-positive result.
If you’re curious about having the Cologuard test, especially if you’re in that sizable group called “colonoscopy procrastinators,” read more about it on their website.
Want to try the new test?
If you want to proceed and you’re a WholeHealth Chicago patient, call and schedule lab-only, and please bring your insurance card. This visit is mainly for paperwork, but requires your signature and thus cannot be done online. Our staff will complete the form, copy your card, and fax everything to the people at Cologuard. (If you’re not a WHC patient, ask your primary care doctor for information.)
Doctors’ offices are not supplied with the test kits, just FYI.
You’ll next receive a call from a Cologuard representative who will review your insurance and may, depending of your insurance company, ask you to pay a $50 advance to cover the kit, shipping charges, and the time spent getting prior authorization for insurance approval. This charge does not apply to Medicare patients since Medicare recently fully approved this test.
Once coverage is approved Cologuard will mail you the kit, complete with collection instructions vaguely reminiscent of Mr. Hanky, the Christmas poo character from South Park.
You mail the kit back to them, your test results will be sent to our office, and we’ll contact you.
Paying for Cologuard
If you’re at all familiar with the chicaneries of health insurance you know that “approval” is not the same as “payment.” Cologuard will work to seek full payment (including filing appeals), and you’ll receive in the mail an Explanation of Benefits from your insurer, with the reminder that “This is Not a Bill.”
When all is said and done, like just about everything in health care reimbursement, if your insurer does not pay the full balance after Cologuard’s efforts, the remaining portion becomes your responsibility. If you do get a bill, it may arrive months and months after your test is completed.
Keep in mind that colon cancer is one of the most preventable and yet least prevented cancers in the US today. It’s the third most diagnosed cancer, the second leading cause of cancer deaths in both sexes over 50, and one of the most treatable cancers if found early through a screening test.
Yet one in three adults over 50 still aren’t getting screened as recommended. If you’re in this group, let the Cologuard test change your world.
I’m doing my own this week. Yes, to be honest, I’d rather be in Paris, or even the Dells, than busy collecting my specimen, but then again, I, too, want to…
David Edelberg, MD