Pete Kenworthy wasn’t looking forward to a colonoscopy, but knew the screening was recommended at age 50.
Then Kenworthy, a former Cleveland news anchor who now works in the marketing department at University Hospitals, heard during a work meeting that UH’s Digestive Health Institute and the American Cancer Society were updating their guidelines for colorectal cancer screenings.
Those new guidelines recommend screenings beginning at age 45 for all people at average risk, without a family history of the disease. The previous guidelines suggested screening start at age 50 for those with average risk and at age 45 for African-Americans.
“I thought, ‘Hold on, did you move the goalposts on me? I’m 47. Whoa, now I have to go get a colonoscopy,' ” said Kenworthy.
Kenworthy said he decided he trusted the new recommendations and wanted to get it off his to-do list.
“I believe all their recommendations and they’re making recommendations in the best interest of the patient,” said the father of three from Kent. “Colonoscopies are one of the few tests that actually prevents cancer. They actually scrape the polyps off. How many tests do that?”
Kenworthy’s procedure is scheduled in May.
“My thinking is: Go get your colonoscopy, get your clean bill of health and move on,” he said.
UH recently changed its guidelines because the American Cancer Society recognizes "a significant number of men and women are being diagnosed with colorectal cancer before age 50,” said Dr. John Dumot, director of UH’s Digestive Health Institute. “We have seen colorectal cancer develop in young patients and often they have no identifiable risk factors like family history of colorectal cancer.”
Dumot said he believes it will take awhile for all practitioners and industry organizations to buy into the "sea change."
According to UH, 1 in 3 adults are not getting the recommended colon cancer screenings.
Adults born around 1990 have twice the risk of colon cancer and four times the risk of rectal cancer compared with adults born around 1950, who have the lowest risk, according to the American Cancer Society.
Colorectal cancer cases have declined steadily over the past two decades in people 55 and over, due to screening programs that result in the removal of precancerous polyps. But there has been a 51 percent increase in colorectal cancer among those under 50 since 1994, according to UH.
Some other area health systems and insurers are updating their recommendations and coverage, but some are not.
Spokesmen for Cleveland Clinic and Western Reserve Hospital Physicians Gastroenterology group in Cuyahoga Falls said they have not changed their recommendations.
Both said they are aware of the changes by some organizations, while others — including the U.S. Preventive Services Task Force — haven't changed their recommendation from 50.
Summa Health has not officially changed its guidelines, but Dr. John Fondran, a Summa general surgeon who specializes in colon and rectal surgery, said his department has moved to recommending colonoscopies at age 45.
“Public guidelines have changed and some are still at 50, but I think everybody who studies this is sure that 45 is at least where we’re going to be going,” Fondran said.
A big question for consumers is whether their insurer will cover the colon cancer screening if it is before the previously recommended age 50. A screening colonoscopy at age 50 or older is usually covered at 100 percent.
Anthem Blue Cross and Blue Shield spokesman Jeff Blunt said it covers colonoscopies at age 50 or earlier for consumers with risk factors. Anthem is aware of the American Cancer Society’s recommendation for colon screenings at age 45, but said other relevant medical organizations, including “the Centers for Disease Control and Prevention, recommend screenings at age 50 for those without risk factors.”
Medical Mutual will cover screenings when there is a family history or other risk factors for those under age 50, a spokesman said. The insurer is evaluating the new guidelines.
SummaCare Chief Medical Officer Dr. Charles Zonfa said the insurer will cover the screenings at 100 percent for those age 45 and older at average risk.
Preventative screening like a colonoscopy can be beneficial to the patient in early treatment of a potential problem, said Zonfa. For the insurer, removing a polyp that could potentially become cancerous is a lot cheaper than cancer treatment.
Plus, Zonfa said, it’s hard enough to get people at age 50 to agree to do a colonoscopy; if patients want to start earlier, that's great.
“If we started to target members at an earlier age, we might have earlier success. We would only benefit from better screening,” Zonfa said.
Summa's Fondran agrees. He’d like to convince all men and women to do some type of colon cancer screening, including home-based tests such as the FIT (fecal immunochemical test), which tests for hidden blood in the stool and is recommended every year or Cologuard, which tests for DNA changes and blood in the stool, and is recommended every three years.
“I’m comfortable with any screening test to get the person in for screening. Do something,” said Fondran. “I think the colonoscopy is the gold standard and that’s what I’d recommend.”
Dumot of UH also prefers a colonoscopy, which are recommended every 10 years unless polyps or cancer is discovered and more frequent testing is then needed.
He recommends the home-based tests — which are usually covered by insurance — only to patients who refuse to undergo a colonoscopy. There are some patients who are not good candidates for home-based tests, such as those with a family history of colon cancer. Also, home-based tests won’t find actual polyps, which when removed reduce the risk of colon cancer, he said.
Dumot said some patients who opt for the colonoscopy are disappointed when polyps are found because they wanted a normal colonoscopy.
“But the fact that a colonoscopy found a colon polyp and it's removed also reduces the risk of colon cancer," Dumot said.
Beacon Journal consumer columnist and medical reporter Betty Lin-Fisher can be reached at 330-996-3724 or firstname.lastname@example.org. Follow her @blinfisherABJ on Twitter or www.facebook.com/BettyLinFisherABJ and see all her stories at www.ohio.com/topics/linfisher.