My thoughts on Cologuard

In my opinion, Cologuard is being misused.

Cologuard, the “Poop in a box” test that is all over TV and now covered by CMS, is being lauded as a cheap, accessible way to screen the masses. If positive, it is understood that patients will need to come in for a colonoscopy, and CMS will now cover that procedure.

Seems like a great way to save costs and increase screening, right? Yes and no.

Cologuard is not much different than the old occult blood stool test cards – the idea is that you go about your business and every three years, poop in a box and see if you’ve developed something big and bad that needs attention.

I liken it to a mammogram. Every year, I get my mammogram and wonder if this is the year I’ll be told I have breast cancer and join the fight that so many others have joined before me. But if you gave me the choice of detecting cancer or going a step beyond and getting the test that would PREVENT cancer, I would opt for prevention every single time.

That test, for colon cancer, is colonoscopy. While directly examining your colon, I can find polyps and remove them, reducing your risk of getting colon cancer because I’ve removed the precursor.

I’m all for reducing healthcare costs, but not at the expense of health.

In my opinion, the appropriate use of Cologuard is in patients who, despite all my exhortations, cannot be convinced to undergo colonoscopy. Because it’s better than nothing, but not better than colonoscopy.