Yes, Please: New Non-Invasive Colon Screening Test (continued from the front page)

In the second study, researchers simulated "recommended screening" for colorectal cancer (colonoscopies at ages 65 and 75), shorter screening intervals and screening beyond age 75 among average-risk 65-year-old Medicare beneficiaries. Recommended screening translated to a net benefit of 64.5 quality-adjusted life-years (QALYs) gained per 1,000 beneficiaries. When screenings were done after age 75, QALYs declined. When the screening interval was shortened from 10 to five years, there was a gain of 0.7 QALYs per 1,000 beneficiaries, but the cost per additional QALY gained was $711,000. This suggests that clinicians may need to change the way they speak with older patients about cancer screening, as life expectancy assessment should better inform cancer-screening decision making.

A DNA test would presumably obviate the need for a traditional colonoscopy among people who test negative for the gene mutations who otherwise might be prescribed one. Even though the U.S. Preventive Services Task Force does not consider the new non-invasive test worthy of only-determinent status for those at colorectal cancer risk, certain cases like the ones highlighted by the two studies might well be safe in opting out of the more invasive test.

Colorectal cancer primarily affects people age 50 and older, and among cancers that affect both men and women, it is the third most common cancer and the second leading cause of cancer-related death in the United States, according to the Centers for Disease Control and Prevention (CDC). Colorectal cancer screening is effective at reducing illness and death related to colon cancer. The CDC estimates that if everyone age 50 or older had regular screening tests as recommended, at least 60 percent of colorectal cancer deaths could be avoided.

Colorectal cancer occurs in the colon (large intestine) or rectum (the passageway that connects the colon to the anus). Most colorectal cancers start as abnormal raised or flat tissue growths on the wall of the large intestine or rectum (polyps). Some very large polyps are called advanced adenomas and are more likely than smaller polyps to progress to cancer.

The U.S. Centers for Medicare and Medicaid Services proposes to cover the Cologuard test once every three years for Medicare beneficiaries who meet all of the following criteria:

  • age 50 to 85 years,
  • asymptomatic (no signs or symptoms of colorectal disease including but not limited to lower gastrointestinal pain, blood in stool, positive guaiac fecal occult blood test or fecal immunochemical test), and
  • average risk of developing colorectal cancer (no personal history of adenomatous polyps, of colorectal cancer, or inflammatory bowel disease, including Crohn’s Disease and ulcerative colitis; no family history of colorectal cancers or an adenomatous polyp, familial adenomatous polyposis, or hereditary nonpolyposis colorectal cancer).

JAMA Internal Medicine, Published online August 18, 2014, http://archinte.jamanetwork.com/article.aspx?articleid=1897548

JAMA Internal Medicine, Published online August 18, 2014, http://archinte.jamanetwork.com/article.aspx?articleid=1897549

FDA News Release, Aug. 11, 2014, http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm409021.htm

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