Cologuard vs Colonoscopy

[Trooper]

It's time for my second colonoscopy, and I am trying to decide on a colonoscopy or the newer Cologuard test.

I had a colonoscopy ten years ago, at age 50, and it came out negative - no polyps. After reading this thread http://www.early-retirement.org/forums/f38/preventative-colonoscopy-shock-91591.html, I checked with my HI provider and determined that both are covered.

Given my pretty good health, and no polyps last time, I'm leaning toward the Cologuard. But on the other hand, I don't have issues with anesthesia and if the Cologuard test is positive, I'll need to have the colonoscopy anyway.

Any thoughts?

TIA

 

[Car-Guy]

Why go thru the colonoscopy if the doctor says the Cologuard is okay for you? Ok, if it's positive you may need the colonoscopy later,,,,,,, butt, that's the route I'd go .......

 

[athena53]

Most of us here have cheerfully agreed that the prep is the worst part- I do the colonoscopy so that I KNOW I'm unlikely to have to go though the prep again in the near future. My tests, however, have turned up a few nasties, starting with the first one.

 

[Alan]

My wife and I have done the colonoscopies but now that we are back in the UK we do the Cologuard test every 2 years (just done our second test this week). We have no family histories of colon cancer or previous colon or bowel issues.

 

[zinger1457]

If you have the Cologuard test and it comes back positive how does the insurance company handle the follow up colonoscopy? I would think at that point it's no longer considered a preventive service and any deductible or OOP comes into play.

 

[Bamaman]

After the age 50, go.for the colonoscopy every 5 years. The penalty to do such a procedure can be death. This is no joke.

My family has a close friend that just died from colon cancer. He was a superstar general surgeon that had done hundreds and hundreds colon cancer surgeries. Too bad he hadn't been tested periodically.

 

[OldShooter]

Especially considering it's only once every five years, why would you want anything but the statistically most effective test? That would be my only criterion even if the insurance wouldn't pay for it. I'd just write the check. Cologuard? I have no idea what it is, but if it's not the most effective diagnostic tool I'm not interested. And conversely.

What criteria would you use to pick a parachute? That's more or less the same thing.

 

[Philliefan33]

Most of us here have cheerfully agreed that the prep is the worst part- I do the colonoscopy so that I KNOW I'm unlikely to have to go though the prep again in the near future. My tests, however, have turned up a few nasties, starting with the first one.

There is no prep necessary for Cologuard. You just collect a stool sample.

(Opening those samples at the lab has to be one of the worst jobs).

 

[Dawg52]

Around here they recommend every 10 years. Probably because insurance pays as a wellness benefit every 10. Had my 2nd one a few months ago and doc said all is fine and to return in 10 years. I'm turning 64 next month. If I make it to 74 I'll see what is recommended then. Things change.

 

[athena53]

There is no prep necessary for Cologuard. You just collect a stool sample.

(Opening those samples at the lab has to be one of the worst jobs).

Thanks- I must have been thinking of another test- I think they can do some sort of MRI or other imaging of an empty colon. Cologuard is the one that tests the sample for cancer DNA. I might actually look into that one as an interim between full colonoscopies if I can get Medicare to cover it.

It might also be a good middle ground for older people; when DH got to 70-something his doc stopped recommending colonoscopies because the intestine thins out with age and apparently perforation is a bigger risk than colon cancer as you get to advanced ages.

 

[Dtail]

I go every 5 years. One of the most preventable cancers.
Guys should get over the concept of the colonoscopy. Best 30 minute nap ever.

 

[Trooper]

If you have the Cologuard test and it comes back positive how does the insurance company handle the follow up colonoscopy? I would think at that point it's no longer considered a preventive service and any deductible or OOP comes into play.

That's the question I thought of about 5 minutes after I hung up the phone with the HI Provider It's a good question and I will call back to find out, if I choose the Cologuard route.

 

[Trooper]

What criteria would you use to pick a parachute? That's more or less the same thing.

Good advice...I'm a scuba diver and I choose my dive equipment carefully.

 

[Teacher Terry]

It is a reasonable choice to have the last one at 70 due to the reason that A stated. Many doctors won't do them after that age. I would do the first colonoscopy at 50 and if no polyps then would probably do the other test.

 

[marko]

After the age 50, go.for the colonoscopy every 5 years. The penalty to do such a procedure can be death. This is no joke.

My family has a close friend that just died from colon cancer.

True and I agree 100%
[-]BUT![/-] HOWEVER!, my doctor also told me of risks in getting the colonoscopy. I forget the exact number but he said something like 3 out of 1000 colonoscopies end in death and 20 out of 1000 have complications.

My most recent colonoscopy went just fine, but 9 hours later I was back in the ER (Emergency Room) having my gallbladder removed; not sure if there was a connection....

 

[Rianne]

Cologuard is my choice. It is accepted by insurance and is approved by FDA. It is 95% accurate in cancer detection. Yes, colonoscopy removes polyps, benign and precancerous. I do not like anesthesia and try to avoid any surgery. The colonoscopy turns diagnostic if they find a precancerous nodule. If cologuard shows cancer cells, the colonoscopy is diagnostic.

 

[travelover]

....... not sure if there was a connection....

Only if the probe went went wildly off course.

 

[hesperus]

I have personally known 2 people, in their fifties and early sixties, healthy & active, that have died from sepsis when a colonoscopy went wrong. Perforated colons are no joke either. It happens more often than you realize. It makes me wary about getting my second one. I know the risk is low, but the consequences are extremely serious. Thinking of going cologuard for my five year followup.

 

[Montecfo]

I would do the colonoscopy as it is free. The stories about prep are, well, overblown. Plus I know I have some risk due to family.

My internist told me 80pct of cancers are found on first colonoscopies. My first was good so that is somewhat comforting.

I think cologuard has a place and it's worth considering of you are low risk or not a good candidate for colonscopy.

 

[Spock]

The way it was explained to me:
Stool sample tests are basically "just" testing for the presence of blood in the stool. For males, your Dr can do one by cleaning his finger on a test strip after a digital prostrate exam.
Stool sample tests are approx 90% accurate for finding colon cancer... so to get adequate detection you need to do one every year (lots of 90% chances to detect it).
By the time a stool sample detects a problem, its a real problem.

Colonoscopies detect much earlier (before blood in the stool).
Colonoscopies run the risk of bowel perforations, involve some sedation, and some find them (or the process) unpleasant.

Place your bets and spin the wheel.

 

[Teacher Terry]

Just realized I can't do the colonguard due to bleeding hemorrhoids. My first showed no polyps 10 years ago. Not sure if I will have 1 before age 70 or not. My friend had one at 74 and just spent a week in the hospital from it.

 

[athena53]

Stool sample tests are approx 90% accurate for finding colon cancer... so to get adequate detection you need to do one every year (lots of 90% chances to detect it).
By the time a stool sample detects a problem, its a real problem.

The fecal occult blood test is a test for the presence of blood in the stool and that is NOT very specific or accurate. Cologuard tests for cancer cells (looks for that type of DNA) and is far more accurate.

 

[SumDay]

My ER provided health insurance wouldn't cover the Cologuard - processing is ~$500. Colonoscopy is free, as of right now.

 

[6miths]

The way it was explained to me:
Stool sample tests are basically "just" testing for the presence of blood in the stool. For males, your Dr can do one by cleaning his finger on a test strip after a digital prostrate exam.
Stool sample tests are approx 90% accurate for finding colon cancer... so to get adequate detection you need to do one every year (lots of 90% chances to detect it).

Perhaps it wasn't explained to you correctly or by someone with dated information. As pointed out by others, Cologuard is not a simple fecal occult blood test. It tests for the common mutations that occur in the cells of the colon that make them cancerous. It tests for several mutations and has a sensitivity of about 92% for colorectal cancer. As pointed out it is done on a stool sample: no prep, no anesthetic, no invasive scope each with their attendant risks. The sensitivity of colonoscopy is not 100% for detecting colon cancer and in community settings it may not be any greater than Cologuard. As stool DNA testing evolves it will almost certainly become more sensitive and specific than colonoscopy. It is definitely dramatically less risky. I have no conflicts to declare in the matter but tests like Cologuard are definitely the way of the future and will ultimately save lives. Just as FOB and colonoscopy screening have in the past.

 

[Rianne]

The way it was explained to me:
Stool sample tests are basically "just" testing for the presence of blood in the stool. For males, your Dr can do one by cleaning his finger on a test strip after a digital prostrate exam.
Stool sample tests are approx 90% accurate for finding colon cancer... so to get adequate detection you need to do one every year (lots of 90% chances to detect it).
By the time a stool sample detects a problem, its a real problem.

Colonoscopies detect much earlier (before blood in the stool).
Colonoscopies run the risk of bowel perforations, involve some sedation, and some find them (or the process) unpleasant.

Place your bets and spin the wheel.

Also consider colonoscopies only reach so far into the colon. Cologuard takes all the cells through the colon as DNA is tested, not just blood. Flat cancers are not detected and colonoscopies detect polyps on the left side of the colon, not so much on the right side. Cologuard captures all the colon cells.