As a gastroenterologist, my primary focus is on preventing colorectal cancer through timely screenings. Lately, though, I’ve been receiving concerning reports from patients regarding a growing trend: Insurance companies are sending colon cancer test kits directly to individuals without prior recommendations from their healthcare providers.
Take Jeff Smith, for instance. He’s a 68-year-old from South St. Paul, Minnesota, who received a Cologuard test kit earlier this year. The accompanying letter implied that his healthcare provider had recommended it and that insurance would fully cover the cost.
The surprising part? Smith had his colon removed a few years back.
Assuming the physician mentioned in the letter was indeed his doctor, Smith felt assured and took the test, which ended up being positive.
His doctor was bewildered, stating he had not ordered any testing and was aware that Smith wasn’t eligible for it. After weeks filled with anxiety, multiple appointments, and an endoscopy, Smith finally discovered it was a false positive, likely stemming from bleeding near his stoma due to dermatitis.
Smith isn’t the only one facing this issue. Reports are surfacing from various regions where patients, despite not being suitable candidates for stool testing, are receiving these kits from major insurance providers, in partnership with Exact Sciences. Colleagues across several states are echoing these concerns, noting that many are receiving kits that don’t match their medical needs.
The unsolicited nature of these screening tests, combined with letters from supposed healthcare providers, can create confusion, particularly among elderly patients. It also damages the trust that is so crucial in the doctor-patient relationship.
Sure, we all want to improve cancer detection rates, but colorectal cancer screening is maximally effective when it’s personalized, based on age, individual risk factors, and medical history. Bulk mailing these tests to patients who don’t need them isn’t the right approach to address healthcare disparities.
This issue seems to be on the rise, especially with current messaging favoring stool-based tests over colonoscopies and other screening methods.
During a recent earnings call, Exact Sciences shared its strategy: “Cologuard first, colonoscopy if necessary.” This contradicts recommendations from major gastroenterology organizations, including the U.S. Preventive Services Task Force and the American Multisociety Task Force on Colorectal Cancer.
According to these organizations, colonoscopy is the first-line screening method for average and high-risk patients, whereas fecal immunochemical testing (essentially fecal DNA testing) should only be considered if the patient declines a colonoscopy.
Colonoscopy is also the benchmark because it’s the only screening that can simultaneously detect and prevent colorectal cancer. It allows for the removal of precancerous polyps, and research suggests that colonoscopy screening can lower cancer rates by about up to 89 percent.
For high-risk individuals, like many of my patients with family histories of colorectal cancer or other related issues, the colonoscopy is simply the only valid option.
Stool-based screening does have its place in addressing screening gaps, but it’s essential for patients to discuss their options with their providers, including both benefits and limitations.
For instance, Cologuard makes errors in more than 7 percent of colorectal cancers, which is roughly 1 in 13 patients. It’s worth noting that over 19 million patients have utilized this test.
Cologuard also comes with a significant false positive rate, with about 1 in 6 patients testing positive, and nearly half of those will have no polyps upon further colonoscopic evaluation. For many, like Smith, these false positives lead to undue stress and sleepless nights.
Insurance companies need to stop dispatching colorectal cancer screening kits without the consent and involvement of the patient’s doctor. Those of us on the front lines should be the trusted partners in guiding patients’ decisions. Ultimately, we can enhance lives by keeping both patients and medical professionals at the forefront of care.
