#103, COLOGARD vs COLONOSCOPY by the numbers

Gut Check Project

Discovery leads to innovation. Innovation usually leads to changes in processes. But that doesn’t always equate to better. Or not necessarily as a replacement.

You may have seen a commercial or two for a commercial product where a walking and talking white box depicts the ease and comfort for checking for colorectal cancer at home. The insinuation is that anyone can simply send in a sample of their “#2” and find out if they have anything to worry about regarding cancer in the lower gastrointestinal tract.

But at what cost is this substitute for the gold standard of colonoscopy screening actually to the patient? What are the accuracy comparisons? What to make of a positive or negative result?

Ken & Eric dive in and discuss the commercial pitch for this method of using fecal DNA vs visual inspection of the colon and what actually might be overlooked for the unsuspecting patient who is trying to remain healthy.

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Bonus Notes covered in this episode:

Does Cologuard detect polyps?

Yes, Cologuard can detect polyps. However, the detection of large polyps (the precursors to colon cancer) is less than half as accurate as a colonoscopy.

Is the Cologuard test as effective as a colonoscopy?

No, the Cologuard test is not as effective as a colonoscopy. Detecting and removing polyps is critical to colon cancer prevention, and Cologuard only detects large precancerous polyps 42% of the time. A colonoscopy detects the same polyps 95% of the time and they are removed during the same procedure.

What does Cologuard detect?

Cologuard can detect 92% of cancers and 42% of large precancerous polyps, the precursor to colon cancer.

What does it mean if your Cologuard test is positive?

If the Cologuard test is positive, it may mean that colon cancer or polyps are present. After a positive Cologuard test a colonoscopy is required for a definitive answer. The Cologuard test has a 13% false-positive rate, which means 1 in 10 positive tests will incorrectly identify cancer or polyps.

Does Cologuard detect cancer?

Yes, the Cologuard test can detect cancer 92% of the time. However, prevention of colon cancer is better than identifying it once you have it. The best way to prevent colon cancer is by identifying and removing precancerous polyps that don’t turn into cancer later. Cologuard only finds 42% of large, dangerous polyps that can turn into colon cancer.

Can patients use Cologuard instead of a colonoscopy?

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

References for this episode:

Uptodate.com- colon cancer screening guidelines

Itzkowitz SH, Ahlquist DA. The case for a multitarget stool DNA test: a closer look at the cost effectiveness model. Gastroenterology. 2017;152(6):1620–1621

Johnson DH, Kisiel JB, Burger KN, et al. Multitarget stool DNA test: clinical performance and impact on yield and quality of colonoscopy for colorectal cancer screening. Gastrointest Endosc. 2017;85(3):657–665.e1.

Zauber A, Knudsen A, Rutter CM, et al. Evaluating the Benefits and Harms of Colorectal Cancer Screening Strategies: A Collaborative Modeling Approach. AHRQ Publication No. 14-05203-EF-2. Rockville, MD: Agency for Healthcare Research and Quality; October 2015.

Knudsen AB, Zauber AG, Rutter CM, et al. Estimation of Benefits, Burden, and Harms of Colorectal Cancer Screening Strategies: Modeling Study for the US Preventive Services Task Force. JAMA 2016; 315:2595.

Cost-effectiveness of a multitarget stool DNA test for colorectal cancer screening of Medicare beneficiaries
Steffie K. Naber ,Amy B. Knudsen ,Ann G. Zauber,Carolyn M. Rutter,Sara E. Fischer,Chester J. Pabiniak,Brittany Soto,Karen M. Kuntz,Iris Lansdorp-Vogelaar

Rex DK, Boland CR, et al. Colorectal cancer screening: Recommendations for physicians and patients from the U.S. Multi-Society Task Force on Colorectal Cancer. GI Endosc. 2017; 86(1):18-33.