As colorectal cancer rates continue to rise among younger people, the American Cancer Society has issued updated screening recommendations, including an endorsement of two new types of stool tests.
Dr. Andrew Wolf, a cancer-prevention expert at UVA Health, led the society’s effort to set the new screening guidelines.
Wolf is a professor emeritus of medicine. (Contributed photo)
He discussed the recommendations with UVA Today.
Q. What are the important takeaways from the new guidelines?
A. We continue to recommend that all average-risk adults be screened for colorectal cancer starting at age 45 through age 75 with any of a number of preferred options, including colonoscopy, a stool test, CT colonography – virtual colonoscopy – or flexible sigmoidoscopy.
The one new preferred option is a multi-target stool RNA test, brand name Colosense, which is similar to the multi-target stool DNA test currently available, known as Cologuard. We are also recommending an updated next-generation version of the Cologuard test, Cologuard-Plus, which appears to be more accurate than the original version and will be replacing it.
Another new development is that we are recommending, as a nonpreferred option, a new DNA blood test for individuals who decline colonoscopy and stool tests. Currently, the only available blood test is called the Shield test, by Guardant Health.
Q. How does this differ from past recommendations?
A. The stool RNA test and next-generation stool DNA test are new preferred options, and the DNA blood test is the first blood test to be recommended, albeit as a nonpreferred option, for colorectal cancer screening.
Q. Will insurance cover these tests?
A. The Shield blood test is Food and Drug Administration-approved, and the Center for Medicare and Medicaid Services has approved it for reimbursement. The stool RNA test is also FDA-approved, but CMS has not yet made a determination regarding coverage.
Also, the U.S. Preventive Services Task Force has not yet weighed in on these new tests. Only tests recommended by the (task force) are required by law to be covered by insurers without out-of-pocket costs for patients. Until they issue recommendations, it is important for folks to check with their insurers to see if they are getting one of the new tests.
The out-of-pocket cost of the RNA test, Colosense, is in the $500 range, similar to Cologuard, and the Shield blood test is in the $1,000 range, so it is critical that folks know if they will be covered. In comparison, a fecal immunochemical stool test, which, if done yearly as recommended, is an excellent screening test, runs $25 to $50.
Q. What is important for people to know?
A. Folks need to know that colorectal cancer is a very curable and even preventable cancer through screening, but that it is often deadly if caught late, so screening and screening regularly is the key. We now have a menu of options, so it’s critical to talk with your doctor about which is best for you.
The new blood test, while obviously an attractive option because it’s just a blood test, is not as good as colonoscopy or the stool tests because it does not do as good a job at detecting precancerous growths – polyps – or early-stage colorectal cancer. It really should only be considered by folks who just won’t complete a stool test or a colonoscopy. But they should know that if the blood test is positive, they’ll need to undergo a colonoscopy.
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