COLOGUARD vs COLONOSCOPY🥊🥊
Many patients are confused about their choice of colon cancer screening. This is due to the very real fear of both the disease, and also the preps associated with the screening colonoscopy. The practice of medicine in recent years has not been immune to marketing and advertising. Such has been the case with Cologuard testing which I first noticed during the Stanley Cup Playoffs a few years ago. I thought uh oh, here we go!
Colon cancer is a leading cause of cancer deaths in the US and around the world. It is however, a preventable disease. Screening and removing pre-cancerous polyps can prevent the disease in most cases. We have seen a significant decrease in colon cancer deaths since instituting screening colonoscopy in the last 3 decades. Colonoscopy is truly the gold standard for screening and prevention of colon cancer.
This brings us to the question of why Cologuard? To answer this I think we should first take a look at the data regarding Cologuard. The test involves taking a ‘crap in the hat’ followed by analyzing a patient’s stool for the presence of blood and abnormal DNA which can be present in the setting of polyps or cancer. The test is very good at detecting cancer. If the test is negative there is over a 90% chance that a patient is free of cancer. However, Cologuard misses up to 8% of cancers. Additionally, Cologuard is not good at detecting polyps, missing 50-60% of polyps.
As stated above, the goal of screening is to prevent colon cancer. This can only be done by finding and removing polyps. Detecting a cancer is akin to closing the barn door after the horse has exited! This is why most specialists such as Gastroenterologists and Colorectal Surgeons recommend colonoscopy as the screening tool of choice, even in average risk patients (age 45, no family or personal history of polyps/cancer). It allows for detection and removal of polyps.
If one pauses the Cologuard commercial, you might be able to read the fine print stating that Cologuard is not recommended in patients with a family history of polyps or cancer, those with a personal history of polyps or cancer, and those with genetic syndromes which predispose them to developing polyps or cancer (Familial polyposis or Lynch syndrome).
Cologuard is recommended for use only in average risk patients who have reached 45 years of age and are symptom free. With this in mind, it is important to consider the limitations of the study when it comes to detection of polyps and cancer. It is also important to remember that if one chooses to use Cologuard as their screening method, colonoscopy is required if positive. In this case the colonoscopy is considered ‘diagnostic’, and therefore will be billed as ‘diagnostic’, not screening, with the patient often being responsible for some or all of the cost depending on their insurance plan and deductible.
Cologuard is certainly easier for the patient, but has the significant limitations noted above. Colonoscopy is a very comfortable procedure, done with sedation/anesthesia. There is no pain associated with removal of polyps or biopsy. The biggest complaint is the prep, which has improved significantly in recent years.
If you simply can’t come to grips with doing a colonoscopy, we understand, that’s part of being human. As health care professionals who specialize in GI care, Gastroenterologists and Colorectal Surgeons are here to help you through the decision process. We will make your colonoscopy as simple and comfortable as possible.
Call us or visit our website to make an appointment or schedule a colonoscopy