Why Colonoscopy is Necessary: 3 Gastroenterologists Speak Up

Colonoscopy has recently come under fire as an expensive, and often unnecessary, test, particularly in a recent article in The New York Times. Here, three gastroenterologists combat these claims and delve into why colonoscopy is a vital tool.

Colonoscopy saves lives
Patients may consider colonoscopies distasteful, both in price and experience, but there is no denying that it gets the job done. Patients with a family history of colon cancer that undergo screening are likely to have their lives saved. However, risk of colon cancer goes far beyond those with a family history.

Dr. Simoni"Unfortunately, 85 percent of colon cancer cases happen in people that are mainly healthy, asymptomatic and have no family history," says Gilbert Simoni, MD, of Los Robles Hospital in Thousand Oaks, Calif.

It is hard to dispute that prevention and early detection of a high mortality rate disease is a significant benefit. "The data is clear. Colonoscopy reduces colon cancer. It has become the treatment of choice because of the ability to detect and remove polyps at the same time," says Brian Muska, MD, with St. Alexius Medical Center in Hoffman Estates, Ill.

The evidence seems clear that colonoscopy is a beneficial test, but misinformation and lack of patient participation persists. "The biggest pet peeve of most gastroenterologists is the myths surrounding colonoscopy," says Dr. Simoni. Part of a GI physician's role in patient interaction is to allay any fears and make plain the truth of colonoscopy.

A large portion of patients' reluctance to undergo the procedure can be linked to its somewhat invasive nature and the unpleasant thought of the preparation. Though not to be confused with a thoroughly enjoyable experience, colonoscopy is far from what most patients imagine. "It is easy to undergo. It is somewhat inconvenient, but the horror stories don't really apply," says Dr. Muska. Patients often find the preparation the most difficult part, not the procedure itself.

Price of colonoscopy
The other aspect that drives patient reluctance is the price. The attitude patients have, especially healthy patients, often boils down to, "Why should I pay for this test when I there is nothing wrong with my health?"

Dr. CreminsThinking beyond the immediate, and slight, inconvenience can really change that attitude. "It has come down in price in the past few years, but the cost of cancer care is not going down," says James Cremins, MD, of Endoscopy Center at Robinwood in Hagerstown, Md. "From a standpoint of saving lives and dollars and cents, this is a win-win from both sides of the equation."

Demonstrating value
Gastroenterologists can defend colonoscopy by staying abreast of the latest developments in technology and focusing on evidence-based medicine. With the right data, GI physicians can produce evidence of colonoscopy's benefits and quality through benchmarking programs. For example, cecal intubation rates and adenoma detection rates can both indicate the necessity and value of colonoscopy.

Demonstrating value is especially important to payers because lack of insurance coverage all but eliminates a patient's ability to undergo a screening. "It has been shown in the lower socioeconomic class, the uninsured don't have access, but they also have an increased risk for colon cancer," says Dr. Muska. Many gastroenterologists respond to this by taking on a number of charity cases.

Even patients with insurance can face obstacles to receiving a colonoscopy. "Some insurance companies don't want to pay for anesthesia. Fortunately, in my area anesthesiologists try to accommodate these patients," says Dr. Simoni. Provider flexibility can assuage some of the financial pressure patients feel.

Many payers will consider a colonoscopy preventative care and provide full coverage, but with a caveat. "If a polyp is found, colonoscopy is no longer considered preventative care, according to most insurance plans," says Dr. Simoni. The patient now becomes responsible for a portion of the bill. In up to 20 percent of cases, a gastroenterologist will find and remove a polyp.

Communicating the importance of colonoscopy
Gastroenterologists have found the one of the best ways to communicate the importance of colonoscopy to patients is through the community. GI physicians work with primary care physicians to talk to patients. Dr. Cremins and his fellow physicians have participated in community forums and radio shows. March is Colon Cancer Awareness Month and serves as a platform for physicians to reach patients and express the importance of the procedure as well as debunk the common misconceptions surrounding it.

Dr. MuskaNew technology for preventative screening
Colonoscopy is a staple of many GI physician practices and the key tool in colon cancer prevention and diagnosis, but many companies are in the process of developing more palatable, non-invasive alternatives. "Right now, those non-invasive tests are not as reliable, not powerful enough to say whether or not a patient has cancer or polyps," says Dr. Muska.

As time passes, the accuracy and availability of these tests will improve. Though these alternatives may seem to compete with colonoscopy, in realty it is unlikely colonoscopy will ever lose its relevance. "In my opinion these tests will make colonoscopy more prevalent. We will always need the ability to remove polyps, which can best be achieved through colonoscopy" says Dr. Simoni.

No matter the changes in technology and the barriers to care, gastroenterologists' goal is to continue using colonoscopy has a way to battle a disease and prevent unnecessary deaths. "If we are going to beat colon cancer, we need 'fair' compensation and patients need access," says Dr. Cremins.

More Articles on Gastroenterology:
Colonoscopy as a Preventative Tool: Q&A With Colon Cancer Prevention Project Founder Dr. Whitney Jones
6 Ways to Improve GI Profits
Stay Competitive: 5 Enhancements for GI/Endoscopy Groups

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