From the Guidelines
Cologuard (Multitarget Stool DNA test) is recommended for average-risk individuals aged 45 to 75 years as a screening option for colorectal cancer, with testing repeated every 3 years if results are negative. This recommendation is based on the most recent and highest quality study available, which suggests that screening for colorectal cancer should start at age 45 years for average-risk adults 1. Average risk means having no personal history of colorectal cancer, advanced adenomas, inflammatory bowel disease, or family history of colorectal cancer.
Key Considerations
- Patients should not use Cologuard if they have a history of positive screening tests in the last 6 months, as this could lead to unnecessary follow-up procedures.
- The test works by detecting altered DNA and blood in stool samples that may indicate the presence of colorectal cancer or precancerous lesions.
- Any positive Cologuard result requires follow-up with a diagnostic colonoscopy.
- While Cologuard is less invasive than colonoscopy, it has a higher false positive rate and may miss some precancerous lesions.
Screening Guidelines
- The American Cancer Society and other organizations recommend that average-risk adults begin colorectal cancer screening at age 45 years with any test, including Cologuard 1.
- The US Preventive Services Task Force (USPSTF) also recommends screening for colorectal cancer in adults aged 50 to 75 years, with a Grade A recommendation 1.
- The decision to screen for colorectal cancer in adults aged 76 to 85 years should be individualized, taking into account the patient's health status, life expectancy, and prior screening history.
Discussion with Healthcare Provider
Patients should discuss with their healthcare provider which screening method is most appropriate for their individual risk factors and preferences. This includes considering the benefits and limitations of each screening test, as well as the patient's medical history and lifestyle. By working together with their healthcare provider, patients can make informed decisions about their colorectal cancer screening and reduce their risk of developing this disease.
From the Research
Cologuard Screening Guidelines
The Cologuard test, also known as the Multitarget Stool DNA test, is a screening tool for colorectal cancer. The guidelines for its use are as follows:
- The U.S. Multi-Society Task Force on Colorectal Cancer recommends that Cologuard be used every 3 years as a second-tier test for average-risk individuals 2.
- The American Cancer Society recommends annual fecal occult blood testing and flexible sigmoidoscopy every 3 to 5 years beginning at age 50 in asymptomatic, average-risk individuals, but does not specifically mention Cologuard 3.
- A systematic review of colorectal cancer screening guidelines found that Cologuard is not frequently mentioned as a recommended screening modality, but colonoscopy, FIT, and CTC are more commonly suggested 4.
- A study on facilitators and barriers to colorectal cancer screening found that patients who were up to date on Cologuard screening had undergone the test in the past three years 5.
Screening Intervals and Populations
The recommended screening intervals and populations for Cologuard are:
- Average-risk individuals: every 3 years, starting at age 50 2.
- High-risk individuals: screening should begin at age 40, but the specific interval for Cologuard is not mentioned 2, 4.
- Individuals with a family history of colorectal cancer: screening should begin at age 40, or 10 years before the age at diagnosis of the youngest affected relative, whichever is earlier 2.
Comparison with Other Screening Tests
Cologuard is compared to other screening tests as follows: