September 14, 2017 Read Original Story

U.S. News compares accuracy of colon cancer screening tests, but what about costs?

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Rating

Fecal Occult Stool Tests for Colorectal Cancer Screening

Our Review Summary

In this brief story, the reporter describes three available fecal occult stool tests used to detect colorectal cancer. The story compares the three on such dimensions as false positives and reductions in cancer deaths.

Since the story is largely descriptive, it is unfortuante that one of the important variables missing from the text is cost; the story only notes that these procedures are covered by Medicare. Readers also would have benefited from a more detailed discussion of each procedure’s debits, as well as of the nature of evidence used to determine each procedure’s accuracy.

Why This Matters

Although most Americans know that a colonoscopy is the gold standard for detecting colorectal cancer, many find prepping for the procedure to be so distasteful that avoidance is a real problem. Fecal stool tests can be a reasonable “plan B” for individuals who need an alternative, as long as folks are aware of the constraints that accompany these tests.

Colon cancer is the third leading cause of cancer death for both men and women, and only removal of premalignant polyps during colonoscopy actually prevents it. These tests, if they reveal something suspicious, will still trigger the need for a colonoscopy.

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

Cost should be a prominent part of this story, as the narrative is engaged in offering comparative advice about procedures, but we only learn, quite late in the story, that Medicare typically covers such screening.

The costs are the key for some patients, especially those with high deductible plans. According to the Healthcare Bluebook, the fair price for a screening colonoscopy is $1383, while stool testing for blood is $46. We could not find FIT on the Blue Book website but found prices online of $99.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Satisfactory

Each of the three tests varies in its ability to catch problems early enough to avoid dying of colon cancer, and this story briefly mentions that variance, with some data for two of the three procedures.

Does the story adequately explain/quantify the harms of the intervention?

Not Satisfactory

Although the possibility of false positives exists for each test, the writer gets specific about that for only one of them, the FIT-DNA test.

Also, colonoscopy comes with a risk of perforation during biopsy procedures.

Does the story seem to grasp the quality of the evidence?

Not Satisfactory

The reader will encounter little information about evidence, aside from a mention that, for the Cologuard FIT-DNA test, no long-term studies have been completed. That leads to inferences that the other two tests have survived long-term testing, but have they? While this story was not necessarily meant to be a review of the evidence, some discussion of how rigorous the research is for each test would help readers make informed decisions.

Does the story commit disease-mongering?

Satisfactory

Detecting signs of colorectal cancer is important.

Does the story use independent sources and identify conflicts of interest?

Not Satisfactory

The two sources commenting on the tests both have received money from Genentech, which makes cancer drugs, and is involved in the business of cancer DNA testing.

Does the story compare the new approach with existing alternatives?

Satisfactory

Comparison is the point of the story, and the text does a good job of this.

Does the story establish the availability of the treatment/test/product/procedure?

Satisfactory

These are all available as noted, and Medicare coverage is explained, which is helpful.

Does the story establish the true novelty of the approach?

Not Applicable

This was a review of the current diagnostic tools for colon cancer, not a new test, so we’ll rate this N/A.

Does the story appear to rely solely or largely on a news release?

Satisfactory

Such a comparison story is unlikely to stem from a press release.

Total Score: 5 of 9 Satisfactory

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