New Guidance Benefits Patients



In the United States, colorectal cancer (CRC) is the second leading cause of cancer death and one of the most preventable through timely screenings.

Many screening methods are available for CRC, but a colonoscopy is the gold standard because it is the only one that can both detect and even prevent colon cancer.

After consulting with their physicians, however, some people at average risk choose a stool-based test to screen for colon cancer. Stool-based tests include the fecal immunochemical test (FIT) and stool-DNA test (Cologuard).

It is important to note that if you have a positive stool-based test result, a follow-up colonoscopy is critical for your health. You are twice as likely to develop advanced colon cancer if you skip your follow-up colonoscopy. During this procedure, the doctor will examine your entire colon and remove precancerous polyps.

In the past, many patients were required to pay out of pocket for this follow-up procedure. However, new federal guidance will soon require health insurance to fully cover the cost of a follow-up colonoscopy to evaluate a positive stool-based test.

“This guidance will help ensure that patients can choose the test that is best for them without worrying about out-of-pocket costs,” Anjee Davis, MPPA, president of Fight Colorectal Cancer told MedicalXpress. “Ultimately, this will save lives and support early detection of colorectal cancer."

This new coverage is for plan or policy years beginning on or after May 31, 2022. Patients should check with their policyholder about this coverage.

"Ensuring individuals have access to this lifesaving screening will significantly reduce suffering and death from this disease," Lisa Lacasse, president of the American Cancer Society Cancer Action Network (ACS CAN), told MedicalXpress.

45 Is the New 50 for Colon Cancer Screening

In 2020, the American Cancer Society (ACS) reported that about 12 percent of all cases of CRC occurred in individuals younger than 50. Patients diagnosed prior to age 50 were more likely to have advanced disease at diagnosis.

Because of this increase in young-onset colon cancer, leading health organizations now recommend screenings starting at age 45, not 50, for all average-risk individuals.

About 60 percent of all colon cancer fatalities in the United States could be prevented if every man and woman 45 or older chose to be screened for colon cancer, according to the ACS.

Prioritize Your Colon Cancer Screening

If you are 45 or older, don’t delay your colorectal cancer diagnosis. When CRC is found at an early stage before it has spread, the five-year survival rate is about 90 percent.

Most health insurance plans under the Affordable Care Act now cover colonoscopy as a preventive screening test for CRC in patients 45 and older.

"This year alone, the American Cancer Society estimates more than 150,000 individuals will be diagnosed with colorectal cancer and more than 52,000 will die from the disease. But colorectal cancer is preventable when precancerous polyps are found and removed through a colonoscopy,” Lacasse told MedicalXpress.

Our gastroenterologists perform colonoscopy screenings at ambulatory surgery centers around the country. Click here to enter your zip code and locate a GI specialist near you.