Colonoscopy, Cologuard or FIT – Which is better?

It’s simple. Colorectal cancer is one of the few cancers that can mostly be prevented – and that is with a high-quality colonoscopy performed by a well-trained and experienced gastroenterologist.

While there are other tests to screen for cancer and find it in early stages, colonoscopy remains the gold standard because it can find precancerous polyps and remove them at the same time, before these polyps can come cancer.

Many hospitals and doctors are recommending less-invasive colon cancer screening tests such as Cologuard® or the Fecal Immunochemical Test (FIT) to start with – even if you haven’t declined or considered a colonoscopy. You may have even seen commercials for Cologuard® on TV.

While these tests are better than no screening at all, there are major differences – from outcomes to cost – to consider.

Let’s take a look at the options.

Five screening tests exist for colorectal cancer. They’ve been ranked by the U.S. Multi-Society Task Force of Colorectal Cancer, which our own Dr. Aaron Shiels wrote about during Colorectal Cancer Awareness Month in the Rockford Register Star.

The Fecal Immunochemical Test (FIT) is a tier 1 at-home screening. It looks for blood in stool samples from a bleeding tumor and detects about 70% of colon cancers and about 30% of large colorectal polyps. Because it is not as effective as colonoscopy for detecting cancer, it should be performed annually. FIT has a false positive rate of about 5%, which again, needs to be followed up with a colonoscopy. FIT testing does NOT prevent colon cancer.

The tier 2 tests are Cologuard®, CT colonography and flexible sigmoidoscopy. Many insurance plans and Medicare don’t cover the cost of CT colonography and it is not available in the Rockford area. Flexible sigmoidoscopy is limited because it visualizes less than half the colon and is not routinely recommended.

Cologuard® is designed to detect microscopic blood as well as abnormal DNA in stool samples. While it’s an at-home test, it can be an expensive one (and not just in terms of cost). Both false positives and false negatives do occur. Cologuard® will miss of 1 in every 13 colon cancers and 60% of larger polyps that are at higher risk for becoming colon cancer. Patients may be reassured by a negative test when they actually have colorectal cancer. And those precancerous polyps that would have been removed through a colonoscopy are likely to be missed. Cologuard® does NOT prevent colon cancer.

Additionally, follow-up colonoscopies reveal that almost half of positive Cologuard® tests are false positive tests. Insurance may cover Cologuard® as a preventative screening benefit, but if you end up needing the follow-up colonoscopy, you may be on the hook for higher copays and out-of-pocket costs because the benefit shifts from being preventative to diagnostic.

Colonoscopy is still the only test proven to prevent colon cancer. Not only is it best at detecting colon cancer, it can also prevent cancer because it allows doctors to remove any precancerous polyps during the test. Colonoscopies prevent colon cancer and reduce rates of new colon cancer by almost 90%.

Which test is right for you?

What’s important to know is colon cancer is the second-leading cause of cancer-related deaths in the U.S. Nearly 1 in 3 adults nationally are not getting screened as recommended. Colorectal cancer has a 90% survival rate when found and treated early, according to the American Cancer Society.

Call us today at 815-397-7340 to schedule an appointment. We can help you find the right combination of tests to fit your age, health history and risk factors.