What is Cologuard?
Cologuard is an FDA-approved alternative to colonoscopy for colon cancer screening. This at-home stool based test looks for abnormal DNA cells passed in stool, which are indicative of cancer, large polyps, and blood. The test results are either “positive/abnormal” or “negative/normal.” There is no indication if the test was positive due to blood in the sample, or abnormal DNA.
Cologuard is similar to an older test known as a FIT test, or fecal immunochemical test. The FIT test looks for blood in the stool. According to many studies, FIT testing on a frequent basis is a very effective (and cost effective) method to screen for colon cancer. A typical FIT test costs around $25, compared with the approximate $600+ of a Cologuard test. Just as with Cologuard tests, any positive FIT test should prompt a followup colonoscopy; this is how the testing ultimately finds/detects/prevents colon cancer.
Colonoscopy vs. Cologuard
How does this test compare to colonoscopy?
It is important to understand the limitations of stool-based colon cancer testing. Cologuard is good at detecting cancer–roughly 92 percent of cancers are found using this test.
Cologuard is far inferior to colonoscopy, however, at detecting polyps (most studies cite a rate of only a 40 percent detection of colon polyps). A negative Cologuard test may give patients a false sense of security that patients are preventing colon cancer, based on the limitation of low polyp detection rates.Cologuard testing also comes with an 8 percent false negative rate.
Colonoscopy remains the gold standard for colon cancer screening and prevention in its ability to find, detect and remove colon polyps while they are small and before they have become cancerous. Colonoscopy exams can prevent cancer, Cologuard tests are only capable of cancer detection.
What happens if my Cologuard test is positive?
All positive Cologuard tests should undergo colonoscopy. Depending on certain insurance carriers, only one colon cancer screening test may be covered per year, and thus a positive Cologuard test may result in the unfortunate reality of needing a colonoscopy in follow up that may not be fully covered by insurance (including Medicare).
In addition, 12 percent of Cologuard tests result in false positive results, which generate unnecessary follow-up testing and anxiety.
Who should not have a Cologuard test?
Cologuard testing is not indicated for high-risk individuals. If you have a family history of colon cancer, or a personal history of colon polyps, you should not undergo Cologuard (or other fecal-DNA based testing). Cologuard is not indicated if you have specific GI symptoms, including rectal bleeding, pain or weight loss.
Who should undergo a Cologuard test?
Colon cancer remains the second leading cause of cancer related deaths in America, and it is highly preventable. It is estimated that regular colonoscopy exams can prevent up to 90 percent of colon cancer related deaths. But, not everyone is willing or able to undergo colonoscopy. If you have serious chronic health conditions, or would otherwise not consent to a colonoscopy, we do believe that any approved colorectal cancer screening test is better than not getting screened, and in this case, Cologuard is a good option.
What do we recommend?
A colonoscopy exam, every 10 years, remains the best single test for the screening, detection and prevention of colon cancer. We believe “seeing is believing,” but further, finding and removing colon polyps while small and treatable is far better than being content with diagnosing colon cancer once it has happened. Removing polyps is far easier than chemotherapy and surgery.
You have options for colon cancer screening, and our providers at Associates in Gastroenterology can help you decide which is the best test for you and your family, based on your own unique health history. We would love to be your gastroenterology practice. Please schedule an appointment either by calling us (719-635-7321) or clicking here to request an appointment.
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Endoscopy Centers of Colorado Springs – Audubon Medical Campus
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Endoscopy Centers of Colorado Springs – St Francis Medical Campus