Almost daily, I have to convince patients to get routine colonoscopies. This never goes smoothly. Some plead to wait another year, while others in their 70s flat out refuse to be subjected to such torture. A colonoscopy is an invasive procedure that involves an unpleasant prep, carries a small risk of perforating the bowel, and is usually accompanied by light anesthesia.
Cancer of the colon and rectum (CRC) is the second-leading cause of USA cancer deaths. 50,000 people die from colorectal cancer annually. All people over the age of 50 are encouraged to have a colonoscopy every 10 years. However, only half of all people who should be screened for colon cancer actually undergo a colonoscopy. Patients with a strong family history may be encouraged to have earlier and more frequent testing.
Last August, the FDA approved Exact Science’s Cologuard, a “the breakthrough test for colon cancer screening that's as easy as going to the bathroom.” Cologuard is a stool test that not only checks for the presence of blood but also actually uses the patient’s DNA to check for cancer.
 was 92.3 percent overall and 94 percent for the earliest and most curable cancer stages — on a par with colonoscopy.<br />
• Detection rates for polyps with high-grade dysplasia were 69.2 percent with Cologuard.<br />
• Specificity for Cologuard is 90 percent for patients with negative findings on colonoscopy.</p>
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Although Cologuard is comparable to colonoscopy at detecting precancerous and cancerous lesions, it also has a higher rate of false positives. According to one study, Cologuard had a 10 percent false positive rate. But over time – since people undergo Cologuard every three years instead of every year – Cologuard becomes more accurate. Cologuard has an advantage to colonoscopy in that it detects lesions on both the right and left side of colon with equal sensitivity, whereas colonoscopy mostly detects lesions on the left side. Patients who postpone colonoscopy but test positive with Cologuard are more easily convinced to have a colonoscopy. </p>
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The $599 cost of Cologuard, which is only covered by Medicare at this time, would be in addition to the cost of a colonoscopy in the event of a positive result.</p>
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Colonoscopy remains essential for some. If you do have a pre-malignant polyp or early-stage cancer, there’s no way of removing it without a doctor actually inserting a scope and taking it out. The greatest benefit of Cologuard is for patients who either can't or won't undergo colonoscopy, preparation or sedation. </p>
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How Cologuard works: The patient receives a collection kit. The sealed containers all fit into a box of approximately 8x8x 6.5 inches. A full bowel movement is placed in the sealed container and returned via a prepaid UPS box to the central lab in Madison, WI. The Cologuard test uses QuARTS (Quantitative allele-specific real-time target and signal amplification) technology. The company’s patented method is similar to PCR (polymerase chain reaction) but affords greater specificity and assessment of DNA changes that happen with colorectal cancer. </p>
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