Don’t Delay Preventive Screening

New Hampshire Gastroenterology’s Dr. Ergen Muso evaluates colon cancer screening options

Published 9/17/2020

Cologuard vs colonoscopy. Which one is the right test for me? Is one better than the other? Is it safe to perform one in a COVID world? Before answering, let’s learn a bit more about these tests.

Colorectal cancer is the 3rd most common cancer diagnosed in both men and women each year in the United States and the 2nd most common cause of cancer death. Fortunately, it’s mostly preventable with the right screening. Unfortunately, not everyone is getting screened and in 2020 it’s expected to cause about 53,000 deaths.

What is Cologuard?
Cologuard is a fairly new, stool-based test, which detects blood in your stool as well as abnormal DNA which raises concern for precancerous polyps. It’s a fairly good test for what it’s meant to be, with high sensitivity to pick up precancerous polyps.

  • There is no special prep
  • No need for time off
  • No changes to your diet or medications
  • Delivered to your doorstep
  • Collect your sample in the privacy of your own home
  • Covered by insurance as a screening test
This sounds great. Then why would I need a colonoscopy? Cologuard is not for everyone. Patients with certain risk factors, like history of polyps, cancer, family history of colon cancer, or inflammatory bowel disease should not have this test. False positive rates also range in the 10-15% range. If negative, it’s recommended to repeat the test in three years.

What happens with a positive test?
If your Cologuard is positive you would need a colonoscopy to find and remove the polyps before they turn into cancer. In this case, the colonoscopy is no longer considered a screening test and will fall under a patient’s deductible.

Is Cologuard a replacement for colonoscopy?
No. Gastroenterologists are increasingly concerned that the direct-to-consumer marketing of Cologuard is overstating its role in helping to solve a serious public health problem. Cologuard is not intended to replace colonoscopy.

What is a Colonoscopy?
A colonoscopy allows the doctor to examine the entire colon for polyps while a patient is sedated. Any polyps that are found are removed to prevent cancer. Colonoscopy is still considered the gold standard test by all the gastrointestinal and cancer societies. Colonoscopy has the highest detection rate of small tumors and polyps and it is the only cancer screening that can prevent colon cancer by removing precancerous polyps. Colonoscopy does require a colon prep and, in most cases, anesthesia for the procedure. Colonoscopies are normally repeated every 10 years, but your doctor may recommend a different timeline based on the findings. The American Cancer Society recommends beginning regular screening colonoscopy at age 45. At CMC, we are taking many COVID-19 precautions and safety measures prior to any procedure. Patients are tested for COVID before all procedures, including colonoscopy.

Which test is best? What matters most is that all patients undergo age-appropriate colon cancer screening of some type and adhere to routine surveillance depending on their specific circumstances. If you’re a patient who is considered high risk for COVID, talk with your doctor about whether Cologuard is right for you. For all other patients, colonoscopy is still the gold standard. This is a preventable cancer—don’t let yourself be a victim.