Two Studies Cite Value of Colonoscopy
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NEW YORK — The best way for people at average risk for colon cancer to prevent the disease is to undergo a periodic test in which the entire lower intestine is screened for precancerous polyps, scientists conclude in two studies.
The findings, to be released today, cast a shadow over the worth of sigmoidoscopy, another test to spot colorectal lesions. Doctors are able to view only the lower portion of the colon through that technique.
For the record:
12:00 a.m. July 27, 2000 For the Record
Los Angeles Times Thursday July 27, 2000 Home Edition Part A Part A Page 3 Metro Desk 3 inches; 100 words Type of Material: Correction
Colonoscopy coverage--A July 20 Times story on colonoscopy was incomplete in its explanation of insurance coverage for the medical procedure. According to the National Assn. of Health Insurers, the procedure is covered as first-line screening by many plans. However, others first require a positive fecal blood test or evidence of colon polyps diagnosed through sigmoidoscopy before a colonoscopy is underwritten. Medicare routinely covers periodic colonoscopy screenings for anyone 65 or older at high risk for colon cancer or for disabled people between 50 and 64. In other circumstances, Medicare first covers all costs for fecal blood screening and sigmoidoscopy before colonoscopy is considered.
The National Cancer Institute and the American Cancer Society recommend screening for colorectal cancer to begin at age 50. While fecal blood tests can be performed annually, most doctors recommend colonoscopy, the most extensive and invasive examination, every five to 10 years.
Studies reported today in the New England Journal of Medicine show that colonoscopy is a powerful tool in preventing the disease.
Doctors have long known that colon cancer incidence increases with age, but they’ve also known that it is the only malignancy that can be prevented through screening. This news has not been spread effectively to the public, doctors say.
“I think we certainly demonstrated that you can make a case for colonoscopy as a primary screening test,” said Dr. David Lieberman, lead author of the largest study ever conducted on colonoscopic screening.
Colonoscopy is an examination of the colon with a flexible tube that allows a doctor to visually inspect the entire colon. Colonoscopy is not cheap. The test can range from $300 to $600. Nevertheless, colonoscopy is covered by all major medical insurers and Medicare. It is the most extensive test for colorectal lesions.
The study focused primarily on men at Department of Veterans Affairs medical centers around the country. Lieberman, who is on staff at the Portland VA hospital and a professor of medicine at the Oregon Health Sciences Center, says screening benefits also hold true for women.
“Virtually all patients who develop colon cancer go through that premalignant stage,” Lieberman said. “If we can find the serious polyps and remove them, we can prevent colon cancer.”
Colonoscopy involves insertion of a long, flexible lighted tube into the rectum for an exam that normally takes 15 to 20 minutes, or 30 to 60 minutes if polyps are present and removed. A pain medication and mild sedative are usually given to help the patient relax.
The National Cancer Institute was among the health agencies last year that tried to spur public interest in screening by recommending a simple fecal test for hidden blood. The quick exam costs about $10.
When blood too small to be seen with the naked eye is spotted, doctors are alerted to a possible lesion. An estimated 130,200 cases of colorectal cancer will be diagnosed in the United States this year. According to the American Cancer Society, the disease is the second-leading cause of cancer deaths in the country and will kill an estimated 56,300 people this year.
