If you fall within the age range of 45 to 85, the American Cancer Society (ACS) advises having a regular colorectal cancer screening regimen. However, opting for a colonoscopy, where a specialized camera is used to examine the colon and rectum for abnormal growths called polyps, isn’t your only choice for taking care of your gastrointestinal health.
You have alternative noninvasive screening options: computed tomography (CT) colonography and/or a stool-based test. Billionaire entrepreneur and Shark Tank investor Mark Cuban shares with Fortune his preference for the relatively affordable and straightforward CT colonography, also known as virtual colonoscopy. Essentially, it’s an X-ray examination that doesn’t require sedation or anesthesia.
“I prefer getting CT versions because although they’re not inexpensive, the out-of-pocket cost is considerably lower than that of a traditional colonoscopy,” says Cuban via email. “This allows me to have one every couple of years and the traditional one every seven.”
Cuban mentions that the out-of-pocket cost for his most recent virtual colonoscopy was below $600, although procedure expenses can vary depending on location. For instance, in the 10038 ZIP code of New York City where Fortune is based, the cost for a virtual colonoscopy with contrast ranges from $496 to $2,613, with a median price of $778 according to Healthcare Bluebook. Meanwhile, a traditional colonoscopy can range from $997 to $10,541, with a median price of $2,712.
Considering that the U.S. Preventive Services Task Force (USPSTF) recommends colorectal cancer screenings starting at age 45 for individuals at an average risk of developing the disease, federal law mandates Medicare and private health insurance to cover the expenses. This should ideally mean that patients won’t have to navigate copays or deductibles. However, the ACS points out that the distinction between a “screening” and a “diagnostic” test may vary among insurers, and not all plans cover every form of colorectal cancer screening.
Moreover, individuals at a heightened risk of developing colorectal cancer may require earlier and more frequent screenings. Consult your doctor regarding which test suits you best, and discuss with your insurer the process of getting it covered.
Dr. Arthur Winer, a gastrointestinal medical oncologist at the Inova Schar Cancer Institute in Fairfax, Virginia, and Dr. Derek Ebner, a fellow in gastroenterology and hepatology neoplasia at the Mayo Clinic in Rochester, Minnesota, elaborate on your options for noninvasive colorectal cancer screenings below.
What is a virtual colonoscopy?
In contrast to the traditional method of colonoscopy, which involves threading a camera called a colonoscope through your colon and rectum, the virtual alternative utilizes X-rays and computer technology to generate 3D images of these organs. However, neither test can be conducted if there is stool present.
“The initial preparation is identical,” explains Winer to Fortune. “You still need to clear out the colon, so you must go through the process of taking laxatives and dealing with frequent bathroom visits.”
Additionally, you’ll be required to consume a contrast solution the night before the procedure. Nevertheless, a virtual colonoscopy typically lasts only 10 to 15 minutes, compared to the traditional method which takes less than an hour. Since you won’t be sedated or anesthetized, you can drive yourself home or return to work immediately and resume normal activities.
Although the CT colonography itself is noninvasive, your radiologist may need to insert a catheter into your rectum to inflate your large intestine with air or carbon dioxide.
“The colon, like any hollow space, will collapse if there’s nothing inside it,” Ebner explains to Fortune. “Radiologists need to use that air or gas to expand the colon so they can examine the inside lining for polyps or abnormalities with the CT images.”
Winer assures that while traditional colonoscopy is safe, with minimal risk of puncturing organs or causing infection, the virtual option further reduces this risk. However, the virtual method does expose you to a low dose of radiation similar to other medical imaging procedures.
CT colonography may be suitable for individuals who are averse to invasive colonoscopies or have issues with anesthesia. According to the USPSTF, the procedure “has reasonable accuracy in detecting colorectal cancer and adenomas (noncancerous tumors)” and should be performed more frequently—every five years instead of every ten. Nevertheless, traditional colonoscopy remains the more comprehensive approach; CT colonography cannot remove polyps and may overlook those smaller than 10 millimeters.
“The advantage of a traditional colonoscopy is that it can both diagnose and potentially treat the issue simultaneously,” says Winer, referring to polyp removal. “Doctors can lasso them and remove them. If they find a tumor, they’ll biopsy it and mark it with ink to indicate its location in the colon.”
Occasionally, during a traditional colonoscopy, the scope may not reach the beginning of the large intestine. In such cases, your doctor may recommend undergoing a virtual colonoscopy to complete the screening process.
What is a stool-based colorectal cancer screening?
For certain individuals, a stool-based test might offer greater convenience.
“Stool-based tests examine your stool for either blood or utilize DNA testing conducted by specialized labs to detect changes in the DNA of cells present in your stool,” Winer informs Fortune. “As the stool moves through your colon, it can collect cells from precancerous or cancerous areas.”
The ACS suggests the following options:
- Fecal immunochemical test (FIT): This type of screening, available over the counter, detects blood that might be hidden in the stool from the lower intestines.
- Guaiac-based fecal occult blood test (gFOBT): Your doctor may provide a kit that uses a chemical reaction to identify hidden blood in your stool. This test requires some dietary restrictions; for instance, you’re advised to abstain from consuming red meat for at least three days before testing.
- Multi-targeted stool DNA test with fecal immunochemical testing (MT-sDNA, sDNA-FIT, or FIT-DNA): Cologuard, the only such test available in the U.S., necessitates a prescription.
Ebner points out a drawback of stool-based tests: they need to be performed regularly, with FIT and gFOBT conducted annually, and Cologuard every three years. If these tests yield abnormal results, a diagnostic colonoscopy will be necessary. However, stool-based tests do not require bowel preparation.
Which colorectal cancer test is best?
“The most effective test is the one that individuals actually undergo,” Ebner informs Fortune. “It’s concerning that approximately one-third of eligible individuals for colorectal cancer screening have yet to undergo screening.”
“One of the benefits of having various options is that it allows individuals to choose what works best for them, especially now that we’ve lowered the screening age to 45,” he adds.
Winer concurs, stating, “From my perspective as an oncologist, any form of screening is better than none. I believe the worst course of action someone could take is to avoid all screening tests and simply hope they don’t develop colon cancer.”
For further information on colorectal cancer screening:
Colonoscopies were provided at no cost, but accompanying “surgical trays” incurred charges of $600 each.
Does Medicare cover colonoscopies? Yes, as well as several other colorectal cancer screening tests.
More Millennials and Gen Xers are succumbing to colorectal cancer, with obesity and alcohol consumption contributing to this trend.
Katie Couric emphasizes that many individuals mistakenly perceive colorectal cancer as a disease primarily affecting men. She urges women to undergo potentially life-saving screenings.
