Not All Colon Cancer Screening Methods Are Created Equal

If you’ve watched television for more than an hour, you’ve probably seen an ad for Cologuard®, an at-home test promoted as a substitute for a screening colonoscopy. Because colorectal cancer is the second leading cause of cancer-related death in the U.S., even patients considered ‘average risk’ should have the facts before making a decision about screening tests. And as the marketing efforts increase for Cologuard® and more patients are asking about it, it’s important to look at some critical differences that could prevent colon cancer before it starts.

  • Cologuard is a stool test that looks for traces of blood and 11 distinct DNA biomarkers, and its only approved use is screening average-risk adults between 50 and 75. So if you have any personal history of colon cancer, colon polyps or conditions like inflammatory bowel disease, iron deficiency anemia, bleeding hemorrhoids or a family history of colon or rectal cancers or polyps, this test isn’t intended for you.
  • A 2014 study of 10,000 people that compared Cologuard® with the FIT (Fecal Immunochemical Test) stool test resulted in a significant number of false negatives – 1 out of every 13 patients.While the study, published in the New England Journal of Medicine, did suggest that Cologuard® was more effective than the FIT test, Cologuard® still missed more than 30 percent of polyps that would soon be cancer. This means there was a lost opportunity to stop someone from getting colon cancer by removing pre-cancerous polyps during a colonoscopy.
  • Cologuard® – like other stool-DNA-based tests – can detect most colon cancers or advanced polyps, but it cannot identify precancerous lesions in their early stages. On the other hand, a screening colonoscopy candetect those early lesions and prevent cancer by removing precancerous polyps – all in one procedure.
  • Under the Affordable Care Act (ACA), colon cancer screenings are considered preventive care and the cost of the test is covered by insurance. But what if your Cologuard® test comes back with a positive result? A colon cancer screening will still be necessary and it won’t be considered preventive anymore, which could result in unexpected out-of-pocket expenses.

While there is a place for Cologuard® in colon cancer screening, those situations are limited to a few instances:

  • It may be a good alternative for patients on blood thinners or those with serious medical conditions.
  • It may be an alternative way to reach patients in very rural areas where screening compliance is already low.

While any test that reduces barriers to getting screened should be considered, it’s important to remember that a colonoscopy is still the gold standard for preventing cancer by detecting early lesions and removing pre-cancerous polyps.

Talk to your gastroenterologist about the best screening test for you.