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What screening tests are available?
Colonoscopy
This is the gold standard for CRC screening. It is an invasive procedure by inserting a long, flexible tube with a camera (colonoscope) to view the whole colon after prior preparation the day before. During the procedure under sedation, polyps can be removed and tissue samples (biopsies) can be taken for further examination. The patients without polys can come back in ten years for the next screening.
This test checks for the presence of hidden blood (invisible from naked eye) in the stool. The hidden blood could come from polys releasing blood from the fragile blood vessels on the surface when feces pass through. Hidden blood can be an indication of CRC or other gastrointestinal conditions. The test
is recommended to be performed annually. The patients with positive testing results are
referred to colonoscopy. There are two types of FOBT:
Guaiac-based FOBT (gFOBT): This test uses a chemical (guaiac) to detect hidden blood in the stool, but has diet restraints before the tests.
Immunochemical FOBT (iFOBT or FIT): This test uses antibodies to detect hidden blood in the stool without diet restraints. It's more specific and sensitive, and more commonly used than gFOBT.
Fecal Occult Blood Test (FOBT)
FIT (Fecal Immunochemical Test)
This newly developed molecular test is called a multitarget stool DNA test with the brand name of ColoGuard®. The test examines DNA for gene mutation and methylation shed by cancer (CRC) or precancerous cells (pre-cancer, advanced adenoma, AA) in the stool in addition to hidden blood. This test is recommended to be performed every three years and the patients with positive results are recommended for colonoscopy.
Other Tests
Other screening tests for CRC include some other imaging tests including Flexible Sigmoidoscopy, Virtual Colonoscopy (CT Colonography), and Double-Contrast Barium Enema.
What are the Pros and Cons of Colonoscopy, FIT, and Cologuard?
COLONOSCOPY
PROS
High sensitivity: Colonoscopy as a gold standard can detect most polyps and cancers in the colon and rectum.
Therapeutic at the same time: Polyps are removed during the procedure, preventing further development into CRC.
Longer screening interval: If no polys are found, colonoscopy is recommended to done every 10 years.
Direct visualization: Colonoscopy allows direct examination of the entire colon, accurately identifying pre-cancer and CRC.
CONS
Invasive: Colonoscopy is an invasive procedure that requires bowel preparation and sedation.
Risk of complications: Although rare, complications such as bleeding or perforation of the colon can occur.
Discomfort: Some people may find the preparation and procedure uncomfortable.
FIT (Fecal Immunochemical Test)
PROS
Non-invasive: FIT is a non-invasive test without the need for bowel preparation or sedation.
High specificity: FIT has a high specificity for detecting hidden blood in the stool, reducing the likelihood of false positives.
Cost-effective: FIT is very affordable, even for out-of-pocket payments.
Convenience: FIT can be done at home with only a small stool sample; the new generation of tests can read results within minutes without sending stool samples back to a clinical lab.
CONS
Limited sensitivity: Some small polyps and cancers may not release blood to the stool, leading to false-negative results.
Follow-up required: A positive FIT may still be false-positive and requires follow-up with a colonoscopy for more accurate evaluation.
Stool collection: Some people may not like to collect stool samples.
More frequent testing: FIT is recommended to be repeated annually.
Cologuard® (FIT-DNA test):
PROS
Non-invasive: Cologuard® is a non-invasive test without the need for bowel preparation or sedation.
High sensitivity: Cologuard® combines FIT with DNA analysis with better sensitivity than FIT alone. It can also detect pre-cancer with 42% sensitivity.
Convenience: Cologuard® samples are collected at home.
Longer screening interval: Cologuard® is recommended to be repeated every three years.
CONS
Limited specificity: The high sensitivity of Cologuard® may be accompanied by a lower specificity, resulting in false-positive results and unnecessary follow-ups.
Sample collection: In terms of stool sample collection, some people may feel even more uncomfortable than the FIT test.
Insurance Coverage Information
Is the DiaCarta iCOLON™ iFOB test kit covered by my insurance?
No. The purchase of this kit is an out-of-pocket cost for consumers. Your insurance would only cover this test kit if your health provider purchased the tests from us. Considering this is a new test on the market, it may take some time for regular insurance to cover the cost. Most FIT or iFOB kits covered by the insurance are traditional tests that require the samples to be sent back to the lab for testing. The iCOLON™ iFOB test kit is very affordable and much more convenient than traditional kits covered by insurance.
Does my insurance cover my colorectal cancer screening tests?
Many insurance plans, including Medicare and private/commercial health insurance plans, cover CRC screening tests as part of preventive care services. However, each insurance plan may have different requirements and policies. Before scheduling a CRC screening test, it's recommended to contact your primary doctors and/or insurance company to confirm the coverage.
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