Everything You Need to Know About Cologuard for Cancer Screening

Cologuard looks for changes in your DNA that could indicate the presence of colon cancer or precancerous polyps. Polyps are growths on the colon’s surface that may develop into cancer.

Cologuard is gaining popularity because it’s far less invasive and more convenient than the traditional colonoscopy test.

There are certainly some benefits to the Cologuard test for cancer screening, but there are drawbacks, too, including concerns about its accuracy. Keep reading to find out if you should consider the Cologuard test to screen for colon cancer.

Colon cancer is the third most common cancer in the United States, with the American Cancer Society (ACS) estimating that over 100,000 new cases will be diagnosed this year.

Even if you’re at an average risk, the ACS suggests that you start screening for colon cancer at age 45 and the U.S. Preventive Services Task Force (USPSTF) suggests that you start at 50. You’re at an average risk if you have no symptoms or family history of colorectal cancer.

Cologuard tests for colon cancer by identifying atypical DNA and traces of blood in the stool that precancerous polyps and colon cancer can cause.

Your doctor will need to prescribe the test for you before you’re able to order a Cologuard kit. You can fill out a form on the company’s website that makes a customized order form for you to bring to your doctor.

If you’re taking the Cologuard test, here’s what to expect:

1. You’ll receive a kit that includes all that you need to collect a stool sample with minimal contact with your stool. The kit includes a bracket and collection bucket, a probe and lab tube set, a preservative solution that will preserve your sample during shipping, and a prepaid shipping label for sending the box back to the lab.
2. Using a special bracket and collection bucket that comes with the kit, have a bowel movement on the toilet that goes directly into the collection container.
3. Using a plastic probe enclosed with the kit, also collect a swab sample of your stool and place that in a special sterilized tube.
4. Pour the preservative solution included in the kit into your stool sample and screw its special lid on tightly.
5. Fill out the form that asks for your personal information, including the date and time your sample was collected.
6. Put all collected samples and information back in the Cologuard box and ship it back to the lab within 24 hours.

While Cologuard and a colonoscopy can both be used as screening tests, they take two different approaches and provide different information.

Cologuard detects proteins that may be shed from colon cancer and polyps. When your doctor performs a colonoscopy, they’re trying to find the polyps themselves.

According to the National Institute of Diabetes and Digestive and Kidney Diseases, colonoscopy does carry a low risk of complications. These include reactions to sedatives or possible puncturing of your bowel. Cologuard carries no such risks.

On the other hand, a 2019 study found that Cologuard:

• can sometimes miss precancerous polyps in its screening, which is called a false negative
• can often miss detecting the presence of larger polyps
• also carries a higher risk of false positives, which a colonoscopy does not

Cologuard and a colonoscopy can be used together to screen for colon cancer. Cologuard works as a noninvasive, first-line test for people at average risk of colon cancer.

Positive results from Cologuard indicate that further testing is needed. People with a negative test result may have the option to avoid a colonoscopy based on the advice of their doctor.

Many health insurance companies cover Cologuard, including Medicare.

If you’re eligible for colon cancer screening (between 50 and 75 years old) and have insurance, you may be able to get Cologuard without any out-of-pocket expense.

If you don’t have insurance, or if your insurance won’t cover it, you may have to pay out-of-pocket. It’s best to call the Cologuard customer care number to find out how much the test might cost for you.

The Cologuard test is designed for people who have an average risk and should be getting tested for colon cancer on a regular basis.

The USPSTF recommends that adults in the United States between 50 and 75 years old get screened regularly for colon cancer. The ACS recommendation is to begin screening at 45 years old.

If you’re at an increased risk of colon cancer because of your family history, any inherited mutations, or other known risk factors, talk with your doctor about beginning screening even earlier.

After the lab evaluates your stool sample, Cologuard test results are sent to your doctor. Your doctor will go over the results with you and address any next steps for further testing if you need it.

Cologuard test results simply show a “negative” or a “positive.” Negative test results indicate that no atypical DNA or hemoglobin biomarkers were found in your stool sample.

That just means that the test did not detect any signs of colon cancer or precancerous polyps in your colon.

If you get a positive Cologuard result, it means the test detected signs of colon cancer or precancerous polyps.

False positives and false negatives do happen with Cologuard tests. In a 2014 clinical study, about 13 percent of results from Cologuard were false positives and 8 percent were false negatives.

If you have a positive result, your doctor will recommend following up with a colonoscopy.

The Cologuard test has several benefits over other kinds of tests.

You can do the test at home, which cuts back on time in waiting rooms or in the hospital having an exam.

Some people are hesitant about having a colonoscopy because it generally requires some sedation.

Cologuard allows you to be screened without having any sedation or anesthesia. However, if your Cologuard test is atypical, it should be followed up with a colonoscopy.

Cologuard also doesn’t require any preparation. You don’t need to stop taking medications or fast before you take a Cologuard test. If covered by insurance, Cologuard costs significantly less than a colonoscopy.

The Cologuard test has some drawbacks, mostly involving its accuracy.

A 2018 research review shows that stool sample testing is not as accurate as colonoscopy when it comes to detecting precancerous polyps and lesions.

False positives can create a lot of unnecessary stress and worry while you wait for follow-up testing. The high levels of false positives associated with Cologuard make some doctors wary of the test.

False negatives — or missing the presence of colon cancer or polyps — are also possible. In a 2014 study, the false negative rate was higher for large polyps.

Since Cologuard testing is somewhat new, there’s not any long-term data available on how this screening method will affect your long-term outlook if you do end up having colon cancer.

Keep in mind that there are other fecal testing kits available aside from Cologuard.

Colon cancer is treatable, but early detection makes a big difference for people who have it. The ACS says that colon cancer detected at its earliest stage has an 80 percent survival rate 5 years after diagnosis. If you’re using Cologuard, the ACS recommends screening every 3 years.

Once colon cancer has progressed to later stages, positive outcomes decline sharply. A colonoscopy is typically recommended every 10 years for people with an average risk of colon cancer.

You may want to address any concerns, fears, and questions you have about both the colonoscopy and Cologuard screening methods at your next routine visit.

Start the conversation by asking about your overall risk of colon cancer based on your health history, or by directly asking your doctor about Cologuard and its accuracy.