James S Amontree, MD
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Port Charlotte, FL 33952

James S Amontree, MD
Dr. James S. Amontree, MD
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Important information about  Medicare and colon cancer screening

Important information about Medicare and colon cancer screening, from Dr. James Amontree.

Medicare covers a test that could save your life. All persons over 50 years of age and younger people with a family history of colorectal cancer, should receive regular checkups for colon cancer.

Until January 1998, all leading scientific authorities agreed that regular screening and early detection could dramatically reduce the annual death toll from colorectal cancer, but Medicare has not previously paid for screening tests. New Medicare rules now provide reimbursement.

Why is this important? Colorectal cancer is the nation's number
2 cancer killer, claiming the lives of 55,000 persons each year,
according to the American Cancer Society.

Why should you have screening tests done?
  Screening can prevent cancer by removing pre-cancerous growths (polyps).
  Early detection diagnoses cancers before they have a chance to spread.
  Up to 80% of colon cancer deaths can be prevented by timely removal of precancerous polyps.

What You Need to Know
Congress passed a new law, which directed Medicare to pay for three tests for colorectal cancer screening which have been shown to detect polyps and cancers early:

  Fecal occult blood tests - will be paid for annually (when ordered by the patient's attending physician) for all patients;
  Flexible sigmoidoscopy - will be paid for once every four years for average risk patients;
  Screening colonoscopy - will be paid for once every ten years for patients with average risk of colorectal cancer and once every two years for high-risk patients.

The final rule from the U.S. Department of Health and Human Services ("HHS") also addresses the possible use of barium enema x-ray as an alternative to the endoscopic examinations for some average and high-risk patients.

More Information About the Options
Fecal occult blood tests, the most common and inexpensive cancer screening device, have an important role in colorectal cancer screening. This test, which can be performed at home and mailed to the medical lab, involves examining a small sample of stool to see if any hidden blood, which you would not be able to see, is present. This test alone is not sufficient for accurate screening. Studies in the Journal of the American Medical Association by researchers at the Mayo Clinic found such stool tests to be only 30% effective in detecting early colorectal cancer. The test can be positive falsely, due to diet or medications. While this test is important, it needs to be combined with one of the other tests  explained below.

Everyone - particularly older Americans and patients with gastrointestinal problems, who usually are among those with an increased risk of colorectal cancer - should know as much as possible about screening options available for colorectal cancer screening. Here are some alternatives to consider:

Flexible Sigmoidoscopy
  Least expensive
  Highly accurate in examining the lower third of the colon
  Since only one-third or less of the colon is examined, cancer arising in the upper colon may go undetected.
  Available generally without precertification once every four years to Medicare beneficiaries over age 50.
  Most reliable
  Visualizes entire colon
  Offers capacity to remove many growths and cancers during the examination
  Cost, however the Medicare fee for this procedure has dropped substantially.
  While colonoscopy is very safe, there is a small risk of injury to the colon.
  Available generally without precertification once every ten years to Medicare beneficiaries over 50. Colonoscopy is also the diagnostic tool used most frequently if patients have positive results on of the other colorectal cancer screening tests.
Barium X-ray
  Usually examines the entire colon: will detect only about half of large polyps and tumors.
  Smaller cancers and precancerous lesions may be missed because radiology crates a "contrast" picture, rather than directly visualizing the colon;
  Cannot be used to biopsy or remove polyps or tumors. When the barium enema identifies a polyp, tumor or other abnormality, a second test, colonoscopy, usually must be performed to confirm any positive results from a barium growth.
  The barium enema test can sometimes miss polyps and tumors.
  The final rule states that "while there is not a consensus in the medical community regarding the specific role of a barium enema examination under the Medicare colorectal cancer screening benefit when compared to the use of the flexible sigmoidoscopy and colonoscopy examinations, there is a sufficient basis for us to include the use of barium enema as part of the new national Medicare coverage for colorectal screening".

Pre-certification always required - Unlike the endoscopic tests which can be provided without restriction, HHS states that in order for a screening barium enema to be reimbursed, a specific written order is required from the patient's attending physician. That written order must consist of the attending physician's certification that "...in the case of this particular individual, that the estimated screening potential for the barium enema examination is equal to or greater than the screening potential that has been estimated for the colonoscopy" (high risk) or "flexible sigmoidoscopy" (average risk) " for the same individual"

Are You a High-Risk Patient?
Medicare says you are a high risk patient if you have:
  A close relative (sibling, parent, or child) who has had colorectal cancer or an adenomatous polyp; or
  A family history of gamilial adenomatous polyposis; or
  A family history of hereditary non-polyposis colorectal cancer; or
  A personal history of adenomatous polyps; or
  A personal history or colorectal cancer; or
  Inflammatory bowel disease including Crohn's disease, or ulcerative colitis.

High-risk patients are entitled to colonoscopy every two (2) years generally without any requirement for any written certifications by the attending physician. In some instances, a barium enema may be substituted.

How to Select a Physician
Screening tests are unequal, so the reliability of results depends on the skills, experience and expertise of the physicians performing the procedures. All of the above tests involve examining the colon, which means these tests are only as good as the physician's ability and experience.

More experienced physicians will have skills in using the instruments - the sigmoidoscope and colonoscope - to get the best picture possible within the colon, which in turn promotes more reliable diagnoses. Colonoscopy allows for both diagnosis and therapy of the course of a single examination. Family physicians and internists perform many flexible sigmoidoscopies. Colonoscopies are most often performed by a specialist, a gastroenterologist like Dr. Amontree. If a polyp is present, the instrument often can be used to remove it at the time it is detected, eliminating the need for either a repeat procedure or surgery. Therefore, particularly with colonoscopy, the more experienced physician is better equipped to take care of the entire problem "on the spot."

The Bottom Line
While it is normal to be anxious about the various screening tests available, you should rest assured that, under most circumstances, none is terribly unpleasant. To get the best, most reliable results, consult you physician about which exam is right for you, and make certain that your exam is performed by a physician who has comprehensive training, skills and expertise.

James S. Amontree, MD, FACP, has many years of experience with colonoscopy. He is happy to answer your questions and set your mind at ease regarding this important test. You can schedule a free consultation to learn more about colonoscopy at the Center for Digestive and Liver Disorders, by calling: 941-764-6664.