The most common cancers diagnosed in men are prostate, lung, and colorectal cancers. Together, they account for 42% of all cases in men, with prostate cancer alone accounting for nearly 1 in 5 new cases. For women, the 3 most common cancers are breast, lung, and colorectal. Together, they account for one-half of all cases, with breast cancer alone accounting for 30% of new cases. According to the American Cancer Society, colorectal cancer death rates declined 53% from 1970 to 2016 among men and women because of increased screening and improvements in treatment. However, in adults younger than age 55, new cases of colorectal cancer have increased almost 2% per year since the mid-1990s.
The CDC website lists several types of colorectal cancer screening, and they are Stool Tests (Guaiac-based fecal occult blood test – gFOBT, fecal immunochemical test – FIT, and FIT-DNA test), Flexible Sigmoidoscopy, Colonoscopy, and CT Colonography. However, how often does your doctor recommend stool tests? Instead, doctors typically recommend colonoscopies. Why? Many outspoken rational doctors and specialists say that it’s all about money. It is very expensive in US. The median cost of a colonoscopy in the US is $2,750; prices can range from $1,250 to $4,800 and more. The fees vary across different regions and can vary greatly if the screening is done as an outpatient vs inpatient procedure. Doing the math – 15M scopes x $2750 each– you’ll find that colonoscopies are a $41.25Billion/yr industry. The Affordable Care Act mandates that both private insurers and Medicare cover the costs of colorectal cancer screening tests, so it is supposed to be free. However, it isn’t all true depending on your insurance.
Most importantly, you should be aware of the risks associated with having a colonoscopy. Colorectal screening is advocated for healthy, asymptomatic people; therefore, the risks from screening are important issues. As it turns out, more than 1,000 studies have reported that serious complications can occur after having a colonoscopy. One study says the incidence of colorectal perforation during examination ranged from 0.2% to 5% and is widely recognized as a serious complication with high morbidity and mortality. Another study showed that for every 1,000 patients with a hole in the colon after the procedure, 51.9 died in the first 14 days. In addition, endoscopes can be cleaned but not sterilized, which is a problem because infection often occurs after the examination. Also, there is concern about the increasingly common respiratory complications, such as aspiration pneumonia, caused by general anesthesia.
As you can see, there are many risks associated with a colonoscopy, so let’s start with a safe fecal occult blood test. Unfortunately, depending on where you live or what insurance plan you have, there might not be many options when it comes to non-invasive screening. However, you might find fecal immunochemical test online without seeing a doctor. For privacy concerns, I personally do not recommend Cologuard since it collects your DNA information.
If you end up having a colonoscopy, be sure to ask the gastroenterologist, “How many of these procedures do you perform per year?” One study found that less than 591 endoscopist-performed procedures per year resulted in frequent bleeding and perforation.Also, be sure to tell them not to allow residents (doctors in training) to do the test.
More than 75% of colorectal cancers occur in people with no (low) risk factors (age, race, genetics, etc.), so this is a lifestyle disease. Please review your lifestyle choices and upgrade them to avoid unnecessary interventions.