General FDA approves blood test to screen for colon cancer

[Eric]

I've decided to ask for a colonoscopy since I'm at the 10 year mark. They just scheduled me for 5 months out, had no idea it would take that long.

 

[Cmaier]

I've decided to ask for a colonoscopy since I'm at the 10 year mark. They just scheduled me for 5 months out, had no idea it would take that long.

i need to schedule one. never had one. my doctor gave me a very disappointed look. I am waiting until i find out if i need surgery for another thing first, but I didn’t realize the wait was so long.

 

[Eric]

i need to schedule one. never had one. my doctor gave me a very disappointed look. I am waiting until i find out if i need surgery for another thing first, but I didn’t realize the wait was so long.

I'm guessing it's because they don't see an urgent need, it's mostly a follow up for my diverticulitis issues. They suspected colon cancer with my friend and got him in within a couple of weeks.

 

[Citysnaps]

I also had one recently at the ten year mark (should have gone back at 5 years, but forgot - and later changed my primary care doctor and clinic). Fortunately, my wait was only about a month. It turned out good. Next appt. is in 5 years.

 

[cbum]

If you are worried about the wait, you can always do the Cologuard or the new Cologuard plus molecular test from a stool sample.

 

[Cmaier]

If you are worried about the wait, you can always do the Cologuard or the new Cologuard plus molecular test from a stool sample.

LOL. I still have a year old test kit from them sitting on a shelf. Seemed like a good idea until I read the instructions. No thanks!

 

[Eric]

If you are worried about the wait, you can always do the Cologuard or the new Cologuard plus molecular test from a stool sample.

My cologuard has come back positive but then the GI doctor said with diverticulitis (especially as active as mine is) that it's common to find blood in the stool and to stop taking that test, that we'll rely on the colonoscopy at the 10 year mark which is now so that's why I'm scheduling.

 

[Roller]

I also had one recently at the ten year mark (should have gone back at 5 years, but forgot - and later changed my primary care doctor and clinic). Fortunately, my wait was only about a month. It turned out good. Next appt. is in 5 years.

After I had my last colonoscopy a few years ago I was told I wouldn’t need another unless I developed symptoms. I guess I’m too old to be worth saving, LOL.

 

[Citysnaps]

What gave me pause about the Cologuard option after talking to my primary care doctor, was the 13% false positive rate and 8% false negative rate.

She said if you have a positive result, you'll still need a colonoscopy to snare the polyp and have it biopsied by a lab. And having some unnecessary worrying while waiting for the colonoscopy and following biopsy.

If instead Cologuard returns a negative result, with an 8% false negative rate, you may end up worrying if you're among the unlucky 8% having cancer. Or... you may believe everything is OK, and find out later you have a serious case of cancer with no options available.

It's been a six months from having the above conversation, so my recollection might not be quite right.

 

[Eric]

What gave me pause about the Cologuard option after talking to my primary care doctor, was the 13% false positive rate and 8% false negative rate.

She said if you have a positive result, you'll still need a colonoscopy to snare the polyp and have it biopsied by a lab. And having some unnecessary worrying while waiting for the colonoscopy and following biopsy.

If instead Cologuard returns a negative result, with an 8% false negative rate, you may end up worrying if you're among the 8% having cancer.

It's been a six months from having the above conversation, so my recollection of the conversation might not be quite right.

For me there's always been traces of blood due to the diverticulitis, it's what caused me to get the first colonoscopy almost 10 years ago and it came up totally clean with no polyps but they did confirm the diverticulitis diagnosis. Now it's just a matter of following up.

 

[cbum]

common to find blood in the stool

Just to clarify, the Cologuard doesn't check for blood, it checks for Colorectal cancer-specific molecular DNA markers.
Detecting occult blood is a much older and less sensitive & specific screening method.
The newer Cologuard plus has a Sensitivity/Specificity of 95%/94% in average risk populations, which is about the same as Colonoscopy.
The advantage of Colonoscopy is that if you see something, you can biopsy it.
The advantage of the molecular test is that it is non-invasive and do it yourself, and tells you if you can skip the Colonoscopy for a few years. And yes, you have to deal with your poop - sorry...

 

[Eric]

Just to clarify, the Cologuard doesn't check for blood, it checks for Colorectal cancer-specific molecular DNA markers.
Detecting occult blood is a much older and less sensitive & specific screening method.
The newer Cologuard plus has a Sensitivity/Specificity of 95%/94% in average risk populations, which is about the same as Colonoscopy.
The advantage of Colonoscopy is that if you see something, you can biopsy it.
The advantage of the molecular test is that it is non-invasive and do it yourself, and tells you if you can skip the Colonoscopy for a few years. And yes, you have to deal with your poop - sorry...

Just went back and looked and I misspoke, it was a fecal occult test (FIT). I was then referred to the GI doctor who said to stop taking them because my condition will likely show it positive every time.

 

[DT]

Just to clarify, the Cologuard doesn't check for blood, it checks for Colorectal cancer-specific molecular DNA markers.
Detecting occult blood is a much older and less sensitive & specific screening method.
The newer Cologuard plus has a Sensitivity/Specificity of 95%/94% in average risk populations, which is about the same as Colonoscopy.
The advantage of Colonoscopy is that if you see something, you can biopsy it.
The advantage of the molecular test is that it is non-invasive and do it yourself, and tells you if you can skip the Colonoscopy for a few years. And yes, you have to deal with your poop - sorry...

Yep, modern Cologuard is significantly better than a FIT screening.

I may have previously posted this here, but a very good friend of mine who's a Doc (kind of semi-retired, and one of the best, not only hands on practice but ran a large, multi-institutional hospital group), said: "With Cologuard, if you're OK with this very accurate test, like you can get it, and with a negative result, just get on with your life, that's plenty. If you just can't live without the potentially additional cover an actual colonoscopy might provide, then just go directly to that procedure".

To be clear, that also comes with some caveats, like no symptoms, clear blood work, not in a risky group / family history, etc. (Disclaimer: this is not meant as medical advice).

I think there's a big issue from a mental health/anxiety standpoint, where if a Cologuard does return positive, you're left with a potentially long period waiting for a follow-up colonoscopy and losing your mind.

Side note, since it's kind of an unavoidable part of this convo, the, umm, sample delivery for a Cologuard, is mostly just kind of funny, even the idea of waiting for a "good opportunity" made me and the wife chuckle It sounds gross-tacular, but if you've had kids, it's a lot less gross than most infants

 

[Eric]

Yep, modern Cologuard is significantly better than a FIT screening.

I may have previously posted this here, but a very good friend of mine who's a Doc (kind of semi-retired, and one of the best, not only hands on practice but ran a large, multi-institutional hospital group), said: "With Cologuard, if you're OK with this very accurate test, like you can get it, and with a negative result, just get on with your life, that's plenty. If you just can't live without the potentially additional cover an actual colonoscopy might provide, then just go directly to that procedure".

To be clear, that also comes with some caveats, like no symptoms, clear blood work, not in a risky group / family history, etc. (Disclaimer: this is not meant as medical advice).

I think there's a big issue from a mental health/anxiety standpoint, where if a Cologuard does return positive, you're left with a potentially long period waiting for a follow-up colonoscopy and losing your mind.

Side note, since it's kind of an unavoidable part of this convo, the, umm, sample delivery for a Cologuard, is mostly just kind of funny, even the idea of waiting for a "good opportunity" made me and the wife chuckle It sounds gross-tacular, but if you've had kids, it's a lot less gross than most infants

It appears Kaiser takes the approach that if there is even a trace of blood for any reason that you need a follow up colonoscopy, as it's still the gold standard and rules out any false-positives/negatives.

Here's the Google version:

Kaiser Permanente doesn't use Cologuard because it recommends annual FIT tests as a less expensive and simpler alternative for average-risk patients, and because Cologuard is less effective at detecting dangerous polyps than a colonoscopy. While Cologuard has a high detection rate for cancer, its false-positive rate is also higher, and a positive result always requires a follow-up colonoscopy for definitive diagnosis and treatment. Therefore, Kaiser focuses on the annual FIT test and colonoscopy for both screening and diagnosis. [1, 2, 3, 4, 5, 6, 7]

Why Kaiser recommends FIT over Cologuard

• Cost: The FIT test is significantly less expensive than Cologuard, making it a more cost-effective screening option for a large population.
• Simplicity: FIT tests are often administered annually, which is a common and effective screening schedule.
• Accuracy: While Cologuard is more sensitive for cancer, FIT is still a valuable screening tool and a positive result, just like a positive Cologuard, necessitates a follow-up colonoscopy. [1, 2, 4, 5, 6, 8]

Why Cologuard may not be ideal

• False positives: Cologuard has a higher rate of false positives than FIT, leading to more unnecessary colonoscopies for patients who don't have cancer.
• Missed polyps: Cologuard misses a significant number of precancerous polyps that a colonoscopy would find.
• Cost: Cologuard can be more expensive to administer than FIT, especially if there are no insurance coverages, leading to higher costs for both the patient and the healthcare system. [1, 2, 4, 5]

Why colonoscopy remains the gold standard

• Highest accuracy: Colonoscopy is the most sensitive test for detecting colon cancer and precancerous polyps.
• Therapeutic potential: During the procedure, doctors can remove polyps, reducing the risk of future cancers.
• Diagnostic certainty: A colonoscopy provides a definitive diagnosis, eliminating the uncertainty associated with stool-based tests. [1, 5, 6, 9]

AI responses may include mistakes.
[1] https://www.jackson.org/partners/issues/partners-magazine-fall-2022/the-truth-about-cologuard-tests/
[2] https://www.cancer.gov/news-events/...shield-blood-test-colorectal-cancer-screening
[3] https://wa.kaiserpermanente.org/static/pdf/public/guidelines/colon.pdf
[4] https://agcosprings.com/procedures/colonoscopy-vs-cologuard/
[5] https://kffhealthnews.org/news/colon-cancer-screening-five-things-to-know/
[6] https://www.cancer.gov/news-events/cancer-currents-blog/2022/positive-fit-stool-test-colonoscopy
[7] https://healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.colorectal-cancer-screening-care-instructions.ut3436
[8] https://www.cdphp.com/-/media/files/providers/toolkits/colorectal-cancer/colorectal-cancer-screening-with-fit-vs-cologuard.pdf
[9] https://www.mayoclinic.org/diseases-conditions/colon-cancer/in-depth/colon-cancer-screening/art-20046825

 

[fischersd]

Doctors are like any other profession - they have a range of performance. Not getting good service, switch doctors until you get one that you respect that's doing what you want. I've seen far too many physicians that are completely inept. Fired.

Now, on the topic of colonoscopies - I've (unfortunately) had to have them every 5 years since turning 35 due to family history on my Mom's side. If you have a bad experience, change doctors and tell the new one about your experience. There's sedation that they can use that greatly improve the experience. (generally, you don't remember a thing). Oh - and do the big jug for your scope prep!!! Doing thorough prep in advance means fewer enemas on the day of.

Colon cancer is one of the most preventable forms of cancer - easy to catch it early if you're getting regular colonoscopies.

 

[rdrr]

LOL. I still have a year old test kit from them sitting on a shelf. Seemed like a good idea until I read the instructions. No thanks!

I laughed when my doctor gave me a test kit for my reported (at the time) long bout of loose stools. It was a collection device, three scooping sticks, and separate testing papers, along with sample vials. I told them, I am not a scientist!

Why hasn't there been a development of a pill you take, that will analyze your whole GI as it moves through your system? Kinda like that old movie Fantastic Voyage!

 

[cbum]

big issue from a mental health/anxiety standpoint, where if a Cologuard does return positive, you're left with a potentially long period waiting for a follow-up colonoscopy

Keep in mind that if you have a positive Cologuard, your colonoscopy is no longer for screening, and you go to the front of the scheduling line.

 

[DT]

Keep in mind that if you have a positive Cologuard, your colonoscopy is no longer for screening, and you go to the front of the scheduling line.

That's what one would think, but depending on your location, existing conditions, insurance, etc., that can still take a long time (saying this from some direct feedback/experience from other Doc friends and people who've had to follow up)

And I say "long time" relative to the anxiety, it may not be calendar long so to speak.

But that was just an aside, something that's a "negative", I see people post about (like, "I should've just gone directly to the colonoscopy now I'm freaked out for X days/weeks"), though as you pointed out, clinically, the timeline is greatly compressed on a positive result (even it it feels like an eternity)

I'd also mention, Eric's post above has some protocols that are clearly intended as more "maintenance/monitoring" after a colonoscopy (otherwise they'd be suggesting conflicting recommendations).

 

[Eric]

I'd also mention, Eric's post above has some protocols that are clearly intended as more "maintenance/monitoring" after a colonoscopy (otherwise they'd be suggesting conflicting recommendations).

Which is seemingly why they have no problem scheduling it 5 months out. However, before my first colonoscopy I had a CT scan that showed a mass and they suspected cancer and scheduled me within a week so they moved fast. Turned out to be thickening from diverticulitis, which sucks but isn't generally life threatening unless you get a perforation. So that's why it's now a matter of maintenance.

 

[DT]

Which is seemingly why they have no problem scheduling it 5 months out. However, before my first colonoscopy I had a CT scan that showed a mass and they suspected cancer and scheduled me within a week so they moved fast. Turned out to be thickening from diverticulitis, which sucks but isn't generally life threatening unless you get a perforation. So that's why it's now a matter of maintenance.

Whew! Glad that's how it turned out. I mean, I wish none of us had anything wrong, but at some point in your life, you start being thankful for "Well, this is kind of shitty, but I can live with it!"