The Truth About Colonoscopy, Pt. 1

An issue of Information BEFORE Consent

In my practice at Tenpenny Integrative Medical Center, I frequently get asked this question: Should I get a colonoscopy?

I generally answer like this:

I have long had reservations about  ‘routine’ colonoscopy screening based on age. I’ve seen complications and I’ve never been convinced the test is as beneficial for routine screening as promoted, especially in asymptomatic persons with no family history of colon cancer. Afterall, ‘finding it early’ – and then directing someone to surgery and chemotherapy - is not cancer prevention.  

Of course, that was often met with skepticism from patients, and with hysteria from the mainstream medical community. Let’s explore this topic - especially since a new 10-year study, released in October 2022 in the New England Journal of Medicine and discussed in Part 2 of this four-part series, has dared bravely questioned this stalwart procedure.

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Colonoscopy is the most commonly used method to screen for colon cancer, which is said to account for around 10% of all cancers globally. It is second leading cause of cancer death in men and women [combined] in the U.S.  As of 2020, approximately 69% of adults aged 50 to 75 years have had a least one colonoscopy, representing 62.3 million people. Colon cancer is usually diagnosed when a person is in their 60s and it is more common in African Americans. For more stats about colon cancer go here.

A Short History of Colonoscopes

The first fiberoptic colonoscope was developed by Drs. William Wolff and Hiromi Shinya of Beth Israel Medical Center in New York City in 1969. This was a huge leap forward over a rigid pipe, called a sigmoidoscope, previously used to peer into the rectum of patients who had signs of cancer. The flexible scope allows the practitioner to examine the entire length of the colon. By 1973, more than 5,000 colonoscopies had been performed, demonstrating the utility and relative safety of the procedure.  

In 1983, the Welch Allyn Corporation invented the first video endoscope, allowing doctors to see the procedure and view the colonic mucosa on-screen. Previously, they could only see the tissues through a small eyepiece. 

Although the exam was continually recommended from its inception, it wasn’t widely embraced until the American Society of Gastroenterology published screening guidelines in the early 2000s. Since then, the recommendations have been updated several times, with the most recent guidelines recommending a baseline screening at 45 years of age (previously, it was 55yo) and the timing of a follow-up screening based on the results/finding of the baseline exam.  (important link)

More than 15 million colonoscopies are performed each year in the U.S. 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.

Is it any wonder doctors always push for this screening?

More Costs To Consider

Nearly everyone who has a colonoscopy will have to pay some of the cost out-of-pocket.

• Uninsured patients will likely be responsible for the total cost of their exam.

• Patients with health insurance will be responsible for paying their deductible, copay, and coinsurance amounts. The amount will depend individual health plans.  

• Other expenses may include: the cost of the prep, cost of pain medications after the procedure,and of course, if there are complications, fees and costs may soar.

This site can give you information about the costs of a colonoscopy in your area.

This site, called New Choice Health, allows you to search for the best pricing in your area.

With so many people out of work, under-employed, or without medical insurance coverage, be sure to shop around for the best pricing on any medical procedure you may be having, not just a colonoscopy. You may be very surprised what you may find by reviewing this site.

What does a colonoscopy procedure entail?  

Prior to the exam, you must clean out your colon so the physician has a clear visual field for examining the lining of your colon. This site gives a good overview of what to eat and how to best prep your colon before your procedure.

During the procedure, a long, flexible tube (colonoscope) with a tiny video camera is inserted into the rectum.  Scopes can vary somewhat in size but most commonly, they are 168cm (66 inches) long and about 13mm (0.5 inches) in diameter. The time required to complete the scope can vary greatly, from less than 10 minutes to more than 60 minutes in difficult cases.

Conditions that can prolong the procedure include inadequate bowel cleansing (most common), advanced age, constipation, surgical history, and low body mass index (BMI). If necessary, polyps or other types of abnormal tissue can be removed through the scope during a colonoscopy.  

A Word about Polyps

Polyps are irregular growths in your bowel. They are classified based on size and type to determine their risk of becoming colorectal cancer.  While colon cancer is found in only about 40 out of 10,000 screening colonoscopies, almost all screens result in removing a polyp. In a study of 906 patients, aged 40 to 49 who had colonoscopy screening, it was found that at least 250 persons, maybe up to 1000 persons or more would need screening to detect one cancer. In financial terms, that would mean between $687,000 and $2,750,000 would needed to identify one case of colon cancer in asymptomatic, middle-aged persons.

Here is a case report of the costs of colonoscopy… and why doctors almost always find a polyp to remove: they can bill more. Removing a polyp changes the procedure from “preventive to diagnostic.”

• Total Bill: $10,329 for the procedure, anesthesiologist, and gastroenterologist. Cigna’s negotiated rate was $4,144, and the patient’s share under her insurance was $2,185.

Doctors don’t know why these tiny nodules to develop, but removing them is thought to ‘prevent cancer’ – even though only 5-10% of all polyps will become cancerous.

Coming:

• Part 2: What are the risks of colonoscopy?

• Part 3: What else can I do for screening?

• Part 4: What can I do for colon health?

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