If you’re between the ages of 45 and 85, you should have a colorectal cancer screening routine in place, per the American Cancer Society (ACS). But a colonoscopy—in which your doctor uses a special camera to look inside your colon and rectum in search of abnormal growths called polyps—isn’t the only option to take charge of your gastrointestinal health.
You can choose from noninvasive screening methods: computed tomography (CT) colonography and/or a stool-based test. Billionaire entrepreneur and Shark Tank investor Mark Cuban tells Fortune he enjoys the relatively low cost and simplicity of the former, also called virtual colonoscopy. In short, it’s an X-ray exam that doesn’t require sedation or anesthesia.
“I like getting CT versions because while they are not cheap, the cash price is far less expensive than the cash price of a traditional colonoscopy,” Cuban says via email, “allowing me to get one every couple years and the traditional every seven.”
Cuban says the cash price for his most recent virtual colonoscopy was under $600. Procedure cost may vary by location. For example, in New York City’s 10038 ZIP code where Fortune is located, a virtual colonoscopy with contrast ranges from $496–$2,613 with a fair price of $778, according to Healthcare Bluebook. A traditional colonoscopy ranges from $997–$10,541 with a fair price of $2,712.
Because the U.S. Preventive Services Task Force (USPSTF) recommends colorectal cancer screenings beginning at age 45 for people at average risk of developing the disease, federal law requires Medicare and private health insurers to cover the costs. This means patients shouldn’t need to navigate copays or deductibles. However, the ACS notes the definition of a “screening” versus a “diagnostic” test may vary by insurer, and not all plans cover all forms of colorectal cancer screenings.
In addition, people at high risk of developing colorectal cancer may need screenings earlier and more often. Talk to your doctor about which test is right for you and your insurer about how to get it covered.
Dr. Arthur Winer, a gastrointestinal medical oncologist at the Inova Schar Cancer Institute in Fairfax, Virginia, and Dr. Derek Ebner, a gastroenterology and hepatology neoplasia fellow at the Mayo Clinic in Rochester, Minnesota, explain your options for noninvasive colorectal cancer screenings below.
What is a virtual colonoscopy?
Whereas traditional colonoscopy involves snaking a camera called a colonoscope through your colon and rectum, the virtual option consists of X-rays and a computer creating 3D images of these organs. Neither test, however, can be performed with stool in the way.
“The beginning preparation is the same,” Winer tells Fortune. “You still need to clean the colon out, so you don’t get to get out of taking a bunch of laxatives and having to run to the bathroom.”
You’ll also need to drink a contrast medium the night before the procedure. Even so, a virtual colonoscopy takes just 10 to 15 minutes—the traditional method takes under an hour—and because you won’t be sedated or anesthetized, you can drive yourself home or back to work and immediately resume regular activities.
While the CT colonography itself is noninvasive, your radiologist will typically insert a catheter into your rectum to inflate your large intestine with air or carbon dioxide.
“The colon—just like any hollow space—if there’s nothing on the inside, it’s going to collapse,” Ebner tells Fortune. “The radiologists have to use that air, that gas in order to open up the colon to then see with the CT images, are there polyps or abnormalities along the inside lining of the colon.”
Traditional colonoscopy is safe, with low risk of the colonoscope poking a hole in your organs or causing infection, Winer says; virtual colonoscopy further reduces that risk. The virtual option does come with a low dose of radiation similar to that of other medical imaging.
CT colonography may be a good fit for people averse to an invasive colonoscopy or who have trouble with anesthetics. The procedure “has reasonable accuracy to detect colorectal cancer and adenomas (noncancerous tumors),” according to the USPSTF, and should be done more frequently: every five years instead of 10. Traditional colonoscopy remains the more comprehensive approach; CT colonography can’t remove polyps and may miss those smaller than 10 millimeters.
“The benefit of a (traditional) colonoscopy is that it both diagnoses the problem and potentially can treat it at the same time,” Winer says, referring to polyp removal. “[Doctors] thread a lasso around them and snare them off. And if they find a tumor, they will biopsy it and mark it with some ink to show other doctors where it is in the colon.”
Occasionally, during a traditional colonoscopy the scope is unable to reach all the way to the beginning of the large intestine, Ebner says. When this happens, your doctor may have you undergo a virtual colonoscopy to complete the screening.
Medicare doesn’t cover CT colonography.
Barbara Haddock Taylor/Baltimore Sun/Tribune News Service via Getty Images
What is a stool-based colorectal cancer screening?
For some people, a stool-based test may be more convenient.
“The poop-based tests will screen your poop for either blood, or there’s some DNA testing that the specialized labs do that will look for changes in the DNA of the cells that are in your poop,” Winer tells Fortune. “As the poop passes down your colon, it can pick up cells from these precancerous or cancerous spots.”
The ACS recommends these options:
- Fecal immunochemical test (FIT): Available over the counter, this type of screening looks for blood that may be hidden in the stool from your lower intestines.
- Guaiac-based fecal occult blood test (gFOBT): A kit may be provided by your doctor and uses a chemical reaction to screen for hidden blood in your stool. This test somewhat restricts your diet; for example, you’re encouraged to avoid 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., requires a prescription.
A disadvantage of stool-based tests, Ebner says, is they must be done frequently: FIT and gFOBT annually, and Cologuard every three years. If these tests show abnormal results, a diagnostic colonoscopy will be needed. On the other hand, stool-based tests don’t involve bowel preparation.
Which colorectal cancer test is best?
“The best test is the one that gets done,” Ebner tells Fortune. “What’s really scary is there’s about a third of individuals that are eligible to be screened for colorectal cancer [and] has not yet been screened.
“One of the advantages of having a lot of different options is it then gives the person an opportunity to say, ‘Hey, you know, this is what works best for me,’ especially with us moving the age down to 45.”
Winer echoes, “In my view, as an oncologist, anything is better than nothing—any of these tests. The worst thing I think somebody could do is not do any of them and just hope that they don’t get colon cancer.”
For more on colorectal cancer screening:
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