DID YOU KNOW THERE ARE COST-EFFECTIVE ALTERNATIVES TO A COLONOSCOPY?
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Many people over the age of 50 have their physician recommend a colonoscopy for screening for colonic and rectal cancer. Investing in colorectal cancer screening can save lives as well as medical costs. According to a new study published by the Journal of the National Cancer Institute, colorectal cancer screening programs could cut future, more expensive and invasive treatments for cancer in half.
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Tests for colorectal cancer screening are endorsed by the medical groups of the American Cancer Society, American College of Gastroenterologists, American Gastroenterological Association, U.S. Preventive Services Task Force, and many other medical groups and associations. Since colorectal cancer is the second leading cause of cancer deaths in the U.S., it is unfortunate that only 20% of adults currently get this important screening. Individuals, medical practitioners, medical associations, and government all want to reduce healthcare costs, thus making these screening tests an area for critical review. What is a colonoscopy, what are the alternatives to the traditional colonoscopy, and how do the costs vary between the choices?
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A colonoscopy is a test done by a medical specialist under anesthesia that allows her/him to look at the inner lining of the patient’s large intestine, rectum, and colon. The patient needs to do a colon preparation that last one to two days to thoroughly clear the colon prior to the procedure, and many people find that the preparation is more difficult than the procedure. Under anesthesia, a thin, flexible tube called a colonoscope is inserted into and moved through the rectum and colon enabling the doctor to see ulcers, polyps, tumors, areas of inflammation, hemorrhoids, and areas of bleeding. The colonscope ranges from 48- 72 inches in length and ports a small video camera for internal viewing. During the colonoscopy, tissue biopsies can be collected, polyps or hemorrhoids can be removed, and the results are used as a precancerous or cancer screening. Complications in the colonoscopy procedure may result in a perforation of the colon, work and normal activities need to be postponed for 1- 3 days, and there is a risk for some patients due to the anesthesia.
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There are other tests that can aid physicians in detecting colon diseases. These tests are sometimes done in conjunction with a colonoscopy or in place of the traditional colonoscopy. The most common of these tests are barium enema with x-ray, sigmoidoscopy, blood stool test (guaiac fecal occult blood testing), CT scans, and virtual CT colonoscopy. For the x-ray, a liquid form of barium is inserted into the colon and the contrast from the barium can be seen on the x-ray to show irregularities on the wall of the colon. This test is less accurate than the colonoscopy as often lesions are missed or misdiagnosed.
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A flexible sigmoidoscopy is similar in preparation and medical procedure to the colonoscopy, but this 2 foot long tube and video camera only examine the part of the colon closest to the rectum. Since the scope of this examination is limited, polyps, irregularities, and lesions in the largest part of the colon will be left undiscovered.
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The blood stool test involves taking a series of blood tests that are aimed at informing your physician of any irregularities. In addition, the patient has to collect samples from their stools for at least three days and bring the samples in provided kits to a diagnostic center or the physician’s office for further analysis. Although this is much less invasive than a colonoscopy, the variants in the tests can be attributed to causes other than colorectal abnormalities, and most often these tests are used in conjunction with a colonoscopy, not instead.
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There are two types of CT scans used in diagnosing colorectal abnormalities. The first type is the CT scan using gastrografin which is a liquid similar to barium. The gastrografin is considered an oral contrast that the patient swallows before the CT scan. This liquid is passed from the stomach to the large intestine before the CT scan is conducted. This type of CT scan can be useful in diagnosing both abdominal and colorectal problems, however the preparation for the CT scan is lengthy and many patients don’t like swallowing the gastrografin.
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The second type of CT scan is the newest of the diagnostic instruments and is called the 3-D virtual colonoscopy, computed tomographic colonography, or just virtual colonoscopy. For this test, patients have to cleanse the colon with a preparation prior to the screening similar to what is done prior to a colonoscopy. The actual procedure takes a small rubber tube that is inserted into the rectum through which air can be introduced. A helical CT scan is then performed while the patient lies on their back and then on their stomach, and the results are communicated to a computer which produces the 3-D pictures. The total time for the test is approximately 15 minutes and is much less invasive than a colonoscopy or sigmoidoscopy, there is no anesthesia required, and no barium or gastrografin to ingest. Patients can resume normal activities right after the screening including eating, driving, working, etc. In addition, the virtual colonoscopy has proved to be very effective in diagnosing other types of cancers and abnormalities in the entire abdomen and pelvis and not just within the colon. However, if polyps are found or there is a need for a tissue biopsy, then a colonoscopy will still be needed for removal.
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There is disagreement within the medical profession on how frequently patients should have colorectal screenings. The variables of how often a patient should have colorectal screenings include the patient’s age, previous history of colorectal problems, and family history of colorectal conditions. However, most physicians will recommend colorectal screening tests after the patient is 50 years of age. Many patients do not comply with this directive due to lack of healthcare coverage or lack of colorectal screening coverage even if they do have healthcare coverage (such as with Medicare and Medicaid). In addition, other patients do not like the preparatory cleansing, the invasive procedures, and they don’t want to or can’t miss work.
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The cost of the various procedures may also be a barrier for people to participate in colorectal screening procedures. There is a large range in medical fees for the various procedures with the highest costs coming from a colonoscopy, and the lowest costs from the blood stool testing. For an example, the cost of a colonoscopy including anesthesia can range from an average of $3,200.00- $4,800.00, whereas the typical costs for a virtual colonoscopy are $700.00- $800.00. This is a vast difference in price with almost the same levels of diagnostic reliability.
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Since colorectal screening is the most efficient and best way to treat precancerous or cancerous lesions and polyps, the screenings will save lives, and early detection and treatment of abnormalities will contribute to cutting healthcare costs in half, more work needs to be done to offer safe, effective, comfortable, and affordable procedures for all who need screenings.
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