Cologuard vs Colonoscopy

[Sweepssue]

Colonoscopy

I had a colonoscopy 10 years with no polyps. I am in excellent health with no issues (age 58). I decided to do all of my diagnostic tests and had a colonoscopy last month and had a precancerous polyp. I have a friend that is also 58 and in excellent health (a gym teacher) and she also had a precancerous polyp. The colonoscopy was painless so very much worth drinking the nasty juice. Get the test.

 

[Splash]

Had my annual physical yesterday with a new doctor. Doc surprised me when he said I was overdue for a colonoscopy. I had my 1st one 6 years ago at 50. I was told I was good for 10 years. I still remember celebrating that news.

Doc says because my mom had colon cancer, the standard for me is to have a colonoscopy every 5 years. I am bummed but will have the colonoscopy.

When I was 50, my annual mammogram uncovered that I had triple negative breast cancer which is a very aggressive BC. I believe I am alive today because I never missed an annual mammogram.

I am grateful to be alive every day. I plan to take advantage of the tools that will help me stay that way.

 

[Rianne]

I look at it as a risk vs reward situation. If my doctors say the annual stool test provides a reasonable detection rate that's good enough for me. Yeah, a colonoscopy may discover more issues than the stool test, but where do you stop? If you look hard enough you're gonna find SOMETHING wrong somewhere. Do I get blood tests for every possible disease or health condition? Do I get a CT scan to make sure I don't have a tumor on my brain. Do I get an MRI to make sure something isn't lurking in my body? Do I get an ultrasound on my heart or arteries to make sure I don't have a blockage developing somewhere? Do I get DNA testing to see if I'm likely to get a genetic health condition?

Obviously any of these may be valid tests in certain situations. But I'm not one to go looking for trouble if it's not impacting my life in some way. I could have a squeaky clean colon and still die from some other cancer I didn't screen for. Be cautious but enjoy life. We all die from something.

+1 A huge BC study recently published (June 3) said approx. 70,000 women had unnecessary chemo. Granted the science was not there at the time, but how many of those women are suffering from the side effects of chemo today? I had the Oncotype DX which is a DNA test to see your probability of developing future cancer. Although my score was <5, the oncologists wanted me to have chemo and radiation. I turned both down.

 

[GoodWishes]

I look at it as a risk vs reward situation. If my doctors say the annual stool test provides a reasonable detection rate that's good enough for me. Yeah, a colonoscopy may discover more issues than the stool test, but where do you stop? If you look hard enough you're gonna find SOMETHING wrong somewhere. Do I get blood tests for every possible disease or health condition? Do I get a CT scan to make sure I don't have a tumor on my brain. Do I get an MRI to make sure something isn't lurking in my body? Do I get an ultrasound on my heart or arteries to make sure I don't have a blockage developing somewhere? Do I get DNA testing to see if I'm likely to get a genetic health condition?

Obviously any of these may be valid tests in certain situations. But I'm not one to go looking for trouble if it's not impacting my life in some way. I could have a squeaky clean colon and still die from some other cancer I didn't screen for. Be cautious but enjoy life. We all die from something.

Agree with mountainsoft. Everyone has different medical history/risk. Make well informed choices with you medical professionals.

 

[Homeward Bound]

I think people are way over estimating the risk from colonoscopy. A study from the SEER program using data that is a bit old (late 1990's) from Medicare patients reported 4 death out of 39,000 colonoscopies and this included lots of people who were older than 70 and were getting colonoscopy for reasons other than simple screening.

I don't know the statistics, and speak only from personal experience.

I have a long history of polyps and cancer... my first colon cancer was when I was 15 years old. Have had two resections since then and been "scoped" many, many times. Just scheduled my next one for later this year.

There is a risk with any procedure. That risk needs to be weighed against the risk of not having the procedure done.

For me, given my history of multiple polyps and cancer and surgeries, having the colonoscopy makes sense. For others, the other test (which I have never heard of) may make better sense.

So, as others have suggested, consider your health/age/condition and the risks of doing and not doing, and of one test against the other.

 

[Ian S]

But I'm not one to go looking for trouble if it's not impacting my life in some way.

I really don't understand this mindset. When there are reasonably simple and generally safe tests available to detect progressive potentially deadly diseases early before symptoms appear, then I will take advantage of them. Especially if those tests can lead to treatments that slow, halt or even reverse progression of said diseases. I have known two people including a cousin who succumbed to colon cancer. It's a miserable disease that when not caught early requires nasty treatment combinations of surgery (colostomy bag anyone?), chemo and radiation.

My father went for years with untreated coronary disease that ultimately led to heart attacks the second of which killed him at 65. At least he had an excuse: in the 1950's and 1960's, cardiovascular disease development wasn't that well understood and detection and treatments were lacking.

Today, I take a proactive approach in reducing my risk factors for heart disease and stroke and that includes taking advantage of tests that can provide early warnings for such. Another simple safe test is the one for detecting an aortic aneurysm. That's another killer with little or no symptoms until it kills you. And yea, I also have regular colonoscopies since, in my case, they always turn up polyps. I agree with the recommended regimen - first colonoscopy at 50 then every 10 years if no polyps. By 75, there may well be a reduction in the cost/benefit ratio for colonoscopies for folks who have never had polyps. But for me, when I'm 75, I'll be working with my doctor to study my situation at that time but I expect in the absence of new techniques, I'll continue to get a colonoscopy for some years thereafter.

 

[Trooper]

OP here. Thanks for all of your responses and input. I have decided to go with Cologuard for my screening, based primarily on:

Lack of colon cancer in my family
Lack of any polyps/abnomalities during my colonoscopy 10 years ago
Unwillingness to "go under" if I don't absolutely have to.

I can't say it was an easy decision, and I swayed back and forth.

Thanks again for your responses.

 

[RAE]

Just had my annual doctor appt. the other day (general wellness check), and he highly recommended the cologuard test for me. He said he thinks it is actually a better way to go for guys like me (who have no prior history of polyps, and no family history of colon cancer). He said insurance will definitely cover it. So, I agreed.......just waiting for the kit to come in the mail.

 

[pb4uski]

Interesting... my doc wasn't very enthusiastic about it... wants me to do a colonscopy even though I was clean as a whistle 10 years ago... I may need to discuss it with her again.... I'm not keen on going through that again.

 

[lucky penny]

My doctor has strongly recommended colonoscopies every 5 yrs though I'd never had polyps and have no history of colon cancer. I'm glad he did -- my last one 3 yrs ago found 2 polyps. The doctor who did the procedure gave me color photos as a souvenir & I'll never forget what those suckers looked like. 10 years would have been a long time for them to be growing undetected. I'm planning to have another in 2 yrs even though I'm over 70.

 

[Teacher Terry]

I can’t do the color guard because I have hemorrhoids that bleed occasionally. Had colonoscopy 10 years ago. Not sure if I will have one more at 70 or not. A friend of mine had complications but survived.

 

[check6]

I am impressed with the board knowledge of Cologuard. I have been an investor with the company Exact Science (EXAS) for over three years and plan to use Cologuard for my next screening.

 

[zinger1457]

Just had my annual doctor appt. the other day (general wellness check), and he highly recommended the cologuard test for me. He said he thinks it is actually a better way to go for guys like me (who have no prior history of polyps, and no family history of colon cancer). He said insurance will definitely cover it. So, I agreed.......just waiting for the kit to come in the mail.

I would recommend you check with your insurance company beforehand. My insurer (BCBS) said they would cover the cost but only if my PCP submits a referral to them before taking the test. The lab that performs the test is not part of their network and without the referral they would not cover the cost.

 

[RAE]

I would recommend you check with your insurance company beforehand. My insurer (BCBS) said they would cover the cost but only if my PCP submits a referral to them before taking the test. The lab that performs the test is not part of their network and without the referral they would not cover the cost.

Well, my PCP was going to order the test for me, so I assume that is what BCBS needs.

 

[plsprius]

By the way, an alternative stool test, FIT (fecal immunochemical test), is also an effective and non-invasive screening test, similar to the very expensive Cologuard, and only costs about $25. It's also done via a mail-in sample, or in the doctor's office or even at home.

The FIT has been FDA-cleared for direct-to-consumer, so you can buy it on Amazon.

In any case, the best screening test for you is the one you will actually do, be it colonoscopy, FIT, or Cologuard, etc. Pick your favorite and do it!

PS. I'm not a doctor, so YMMV. But see this article that makes these same points (there's a lot on the web about this): FIT Test for Colorectal Cancer Screening | Berkeley Wellness

 

[TrvlBug]

I can’t do the color guard because I have hemorrhoids that bleed occasionally. Had colonoscopy 10 years ago. Not sure if I will have one more at 70 or not. A friend of mine had complications but survived.

According to my dr. that's no longer an issue with Cologuard. You should discuss with your dr. to see if you are eligible.

 

[Trooper]

As the OP I want to post a follow-up. After weighing all the facts, pros/cons, etc. I decided to go with Cologuard. My test came back negative, so I suppose I will repeat the process in 3 years. I am 60 now.

Interestingly enough my DW, who at first was dead set against Cologuard, opted for Cologuard after a visit with her primary doctor. Her test came back positive, so we scheduled a colonoscopy for her in a couple of weeks. Her gastroenterologist had NOTHING good to say about Cologuard. Says it was rushed to market without adequate testing. I'm trying to take his opinions with a grain of salt given where his bread is buttered, but it made me wonder if 1) did my wife get a false positive? 2) did I get a false negative? and 3) should my next screening be a colonoscopy?

 

[Teacher Terry]

Thug, thanks for the information

 

[ShokWaveRider]

I had a colonoscopy 3 years ago, clean as a whistle.... BUT, after the procedure I got "ischemic colitis". Without getting into the details it was NOT fun and the pain was almost unbearable. Doc said it was caused by dehydration as a result of the prep. Took 2 weeks on a very boring liquid and low residue diet to fix it...… Never Again.

 

[RAE]

Interestingly enough my DW, who at first was dead set against Cologuard, opted for Cologuard after a visit with her primary doctor. Her test came back positive, so we scheduled a colonoscopy for her in a couple of weeks. Her gastroenterologist had NOTHING good to say about Cologuard. Says it was rushed to market without adequate testing. I'm trying to take his opinions with a grain of salt given where his bread is buttered, but it made me wonder if 1) did my wife get a false positive? 2) did I get a false negative? and 3) should my next screening be a colonoscopy?

I think that if my Cologuard comes back positive (and I haven't done it yet), my next step would probably be to do the FIT (fecal blood) test, to see how that comes out. If that also came back positive, then I would definitely schedule the colonoscopy. False positives are always possible with both tests, but I believe there are more false positives (percentage-wise) with Cologuard than with the FIT. The FIT basically just looks for the presence of human blood in the stool, so it seems like it would be pretty hard to screw that up.

 

[RAE]

Here is a short article (written by a gastroenterologist) comparing Cologuard, colonoscopy, and the FIT test (the article is a few years old now, but still interesting).

https://www.medpagetoday.com/gastroenterology/generalgastroenterology/47428

The false positive rate with Cologuard is about 13%, whereas the false positive rate with FIT is only 5%.

 

[check6]

The FIT basically just looks for the presence of human blood in the stool, so it seems like it would be pretty hard to screw that up.

The problem with FIT is that if it comes back positive (blood in sample) you might already be at Stage 2/3. Cologuard detects the "cancer" in polyp stage.

 

[check6]

The best thing about Cologuard is that more people will be screened than otherwise would because of their fear/prepping of/for a colonoscopy.

 

[Corporateburnout]

I just had my 3rd colonoscopy yesterday due to some rectal bleeding from internal hemorrhoids. My PCP recommended the procedure even though my last colonoscopy 4 years ago was clean. Well the doctor removed 3 small polyps but found a larger mass at the ileocecal valve that he was not able to remove but took a couple of samples for biopsy. He said that good thing that my PCP ordered the test otherwise this would have gone unnoticed. Awaiting the biopsy results but he has already scheduled an appointment with a colorectal surgeon in two weeks to discuss treatment options.

I'm 65 with no family history of colon cancer. So for those who think that 10 years between colonoscopies is sufficient think again.

 

[Teacher Terry]

Everyone needs to decide for themselves.