For many people with a new health insurance policy, or those who may be getting screened for the first time, speaking with their physician is only the first step in the screening process. Patients also should review their health plan coverage before the exam to understand what is covered and how their plan interacts with the new PPACA requirements.
Most commercial health benefit plans cannot charge out-of-pocket costs for colonoscopies. While these provisions may seem straightforward, questions remain. For example, the preventive colorectal cancer screening is considered a covered benefit with no out-of-pocket expenses, but what if a polyp is found during the procedure? Would removal of a polyp during the routine screening also be covered? For most commercial health plans, the U.S. Department of Labor has said that a colorectal cancer colonoscopy must be covered with no out-of-pocket cost. It pays for patients to have this discussion with their physician and their health benefit plan representative before the screening to avoid health care coverage misunderstandings.
Considering one in 20 Americans will develop colorectal cancer at some point in their lives, screenings are vitally important as a preventative measure. This year, an estimated 147,000 Americans will be diagnosed with colorectal cancer, and 56,500 will die from the disease. The larger tragedy is that colorectal cancer is one of the most treatable and curable cancers, if detected early. Unfortunately, a high percentage of late stage colorectal cancers are fatal. Colorectal cancer screening with colonoscopy, the gold standard, is an exceptionally effective tool in the fight against this dreadful disease.
Documented knowledge of colon cancer can be traced as far back as 6,000 years ago, when the ancient Chinese proposed different herbs to treat this cancer.¹ The ancient Greek and Indian civilizations also recorded preventative care and treatment plans, such as the use of olive oil, for colon health. In 1932, Dr. Cuthbert Dukes, an English physician and pathologist, devised a classification system for colorectal cancer. But it wasn’t until 1969 that therapeutic colonoscopies began to be used for diagnostic purposes.
Evolution of Screening Techniques
Beginning in the 1940s and through the 1970s, U.S. medical providers and cancer clinics offered rigid sigmoidoscopy to persons who wanted screening for rectal cancer. Then, in the 1960s, the colonoscope was developed thanks in part to advances in fiber-optics and engineering.
In the late 1960s, Dr. Hiromi Shinya, a Japanese-born general surgeon, and Dr. William Wolff conducted research at Beth Israel Medical Center that would revolutionize the diagnosis and treatment of colon cancer. Their work produced colonoscopic techniques using an esophagoscope, which allowed one endoscopist to perform a colonoscopy, rather than the two-person technique, which was previously the standard. In addition, the electrosurgical polypectomy snare was developed for polyp removal, which, at the time, accounted for a large portion of colon surgery procedures. In September of 1969, Wolff and Shinya published their work using diagnostic fiber colonoscopy.² Shinya and Wolff revolutionized the diagnosis and treatment of colon cancer and are recognized as the co-developers of colonoscopy.
Initial colonoscopies were considered so dangerous that they were often done in the operating room or in the intensive care unit. Now, the vast majority of cases are in outpatient settings with extremely low morbidity and mortality rates. Improved instruments, monitoring, anesthesia professionals, and centers especially equipped for gastrointestinal (GI) procedures have all contributed to the increased safety.
In the 1970s, public awareness of endoscopic screening skyrocketed when President Ronald Regan had several polyps removed. This “endoscopic therapy” has been the basis for colonoscopy screening as we know it today.
Sedation Leads to Higher Polyp Detection Rate
Dr. Donald Robert Buechel is amazed by the advancements in colorectal cancer screenings in recent decades. As a board-certified anesthesiologist and professor of Anesthesia (Clinical) Emeritus at Stanford School of Medicine who still attends rounds at Stanford Hospital, Dr. Buechel has had the opportunity to witness the past 50 years of screening developments firsthand. In his opinion, perhaps the greatest achievement that has been made in this area of medicine is the increased safety of anesthesia procedures. These procedures, once relatively risky, are now the gold standard for safe, effective and comfortable colonoscopy screenings.
Most recently, the passage of the Patient Protection and Affordable Care Act in 2010 has provided another significant advancement in colonoscopy screening by making it a preventative service that must be covered by health plans. Now more than ever people over 50 can take advantage of this potentially life-saving screening process.
Since colorectal cancer was first identified in ancient times, medical technology has improved in enormous leaps and bounds to bring colorectal cancer screenings and treatments to where they are today. Decades of working with different options have led to the preventative screening colonoscopy with propofol sedation, the gold standard of care, which allows for a safe and comfortable procedure for patients, as well as for an effective test to help detect one of the most treatable cancer(while it is still in its early stages).