Colon Cancer Awareness

Cologuard® is not recommended as a replacement for colonoscopy by the physician at Midwest Gastrointestinal Associates (MGI).

Colorectal cancer is the second leading cause of cancer death in the US when men and women are combined.  It is estimated 1 in 3 adults ages 50-75 are not getting the recommended screening for colorectal cancer.  In Nebraska, only 68.7% of adults ages 50-75 years old are getting their recommended colorectal screening.

Cologuard® is marketed as convenient, noninvasive colon cancer screening test that you can use in the privacy of your own home.  However, this multi-targeted stool DNA test is a source of significant controversy amongst physicians.

Cologuard® markets they have 92% sensitivity for detecting colon cancer.  While this may not sound like a bad test, missing 8 out of every 100 cancers is actually a big deal!  Furthermore, the test is not very accurate – meaning most of the positive test results are actually FALSE positives.  In fact less than 4% of the patients who have a positive Cologuard test will have colon cancer found on colonoscopy!  For these reasons, Cologuard® is not recommended by several of the major medical societies.  If it is recommended as a screening option, it is a second-tier test, meaning colonoscopy is the preferred test.  Colonoscopy is still viewed as the gold standard (best test) for colon and rectal cancer detection and prevention.  Most importantly, colonoscopy is the only test that can actually prevent colon cancer by removing polyps before they become cancerous!

Why Detecting Polyps Matters

Colon polyps are growths in the colon which could potentially become colon cancer.  There are three types of screenings for colon polyps:

1. Colonoscopy – 95% of large polyps detected
2. Stool DNA (Cologuard®) – 42% of large polyps detected
3. Fecal Immunochemical Test (FIT) – 30% of large polyps detected

Unfortunately, the majority of large polyps go undetected with stool tests (FIT and Cologuard®).

When polyps aren’t found and removed you are at risk for developing colon cancer.  Colonoscopy is the gold standard for finding polyps. If polyps are found during a colonoscopy, they are removed during the same single procedure.  This eliminates the need for additional procedures or tests.

If polyps are suspected through FIT or Cologuard®, a colonoscopy must be performed to remove the polyps.  Most insurance providers consider Cologuard® a screening exam which utilizes your preventative health benefit.  Once this benefit has been utilized, they will not cover an additional exam, such as colonoscopy, under preventative benefits.  In other words, you may want to think twice before submitting that stool sample because you may end up paying your deductible and coinsurance for a colonoscopy regardless!

Cologuard® Test: Detection Not Prevention

Cologuard® is designed to detect cancer not prevent it.  A stool test by itself cannot prevent cancer.  Cologuard® can only detect 42% of large polyps and the majority of large precancerous polyps cannot be detected. Cologuard® may give patients a false sense that they are preventing colon cancer by submitting a stool sample at home.

Cologuard® is NOT For Everyone

If you have a high risk of colorectal cancer, you should skip the Cologuard® test.  High risk factors include a family history of colon cancer, concerning symptoms or previous colonoscopy with polyps found.  This will save you time, money, and the frustration of undergoing both tests since a colonoscopy is needed for high risk patients.  In addition, patients with symptoms such as abdominal pain, changes in bowel habits, hemorrhoids or rectal bleeding should not submit a Cologuard® test as this decreases the accuracy of the test.

How Accurate are the non-invasive Stool Tests?

There are two types of stool tests for colon cancer:  Fecal Immunochemical Test (FIT) and Stool DNA (Cologuard®).  FIT detects 70% of colon cancers and 30% of large colorectal polyps. Stool DNA/Cologuard® detects 92% of cancers and 42% of large colorectal polyps.

Cologuard® is better at detecting cancer than FIT (92% vs 70% for FIT), but the false positive rate is higher.  Cologuard® has a 12% false positive rate, and that rate increases as people age.  However, Cologuard® is less accurate than a colonoscopy at detecting polyps of any size.

Can I use Cologuard® instead of a colonoscopy?

No.  Cologuard® is not designed to be a replacement for a colonoscopy, even though advertisements may suggest otherwise.  Dangerous precancerous polyps are not detected with Cologuard® 58% of the time which is significantly less effective than a colonoscopy. However, Cologuard® may be an option for some patients who insist on not getting a colonoscopy.  Even a 42% chance of detection is better than no detection at all.

What is the cost comparison between screening options?

The cost of Cologuard® is around $500.  Part of that cost may be covered by some insurance companies depending on your plan, co-pay, and deductible.  However, if the Cologuard® test is positive, then a colonoscopy will be needed.  A diagnostic colonoscopy is subject to deductibles and coinsurance.

Screening colonoscopy is not subject to copays and deductibles and usually has no out of pocket costs for patients.  For screening colonoscopy, most insurance companies offer screening benefits for those patients who are not at a high risk.