by Joshua Palmer

Angie's List member Mary Kraeszig of Zionsville, Ind., says the colonoscopy she received to screen for colorectal cancer went well, but the required bowel preparation caused severe cramping. "It was most painful," she says.

Some patients forgo the procedure altogether because of the preparation, says Dr. Douglas Rex, a highly rated Indianapolis gastroenterologist and director of endoscopy at IU Health University Hospital. "Even for someone who's had a colonoscopy performed, they might not want to go through the prep again," he says.

Although some patients find the prep uncomfortable, Indianapolis oncologist Dr. Niraj Gupta says a colonoscopy provides the most thorough evaluation available. But alternative options, such as sigmoidoscopy and fecal occult blood tests, also exist for patients with no family history or other risk factors. "Any screening method is better than nothing at all," Gupta says.

The Centers for Disease Control and Prevention reports that as many as 60 percent of colorectal deaths could be prevented if everyone age 50 and older received screenings.

Each screening alternative carries an important caution to health consumers: "If any of the tests are positive, the colon would have to be evaluated through a colonoscopy," says Dr. Harry Papaconstantinou, communications chair for the American Society of Colon and Rectal Surgeons.

Colonoscopies provide another advantage: Doctors who perform them also remove polyps or do biopsies during the procedure.

For patients like Kraeszig, who prefer not to be sedated because of allergies, a sigmoidoscopy provides an alternative. The test involves inserting a scoped instrument through the rectum to examine only the lower third, or left side, of the colon. Although it requires similar bowel preparation as a colonoscopy, it typically takes less time, costs less and doesn't require sedation.

However, since a sigmoidoscopy only examines a portion of the colon, Papaconstantinou says it fails to detect abnormalities in other areas visible during a colonoscopy. "If you're concerned about being screened for colon cancer, you wouldn't want to exclude the right side of the colon," he says.

The CDC recommends a colonoscopy every 10 years, or a sigmoidoscopy every five years after age 50 in conjunction with fecal occult blood testing annually. FOBT detects blood found in the stool, which may indicate bleeding tumors or precancerous polyps. The test costs far less than more invasive procedures, but it doesn't detect nonbleeding but potentially precancerous polyps. Gupta says it's still more effective than forgoing screening all together. "Studies have shown that it reduces the mortality rate from colon cancer," he says.

Kraeszig says the colonoscopy she received detected polyps. "I'm satisfied I did the right thing in having a colonoscopy," she says. "In the end, I would have still faced a colonoscopy to remove the polyps.

By the numbers

Healthcare Blue Book publishes “fair rates” (the average fee that providers accept as payment from insurance companies) for the following colorectal cancer screenings in the Indianapolis area:

-Colonoscopy $1,070 without biopsy; $1,411 with biopsy

-Sigmoidoscopy $235 (no anesthesia); $637 (anesthesia, if required)

-Fecal occult blood tests $23 to $45 (plus possible offi ce visit fees)

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