At what age should Cologuard (multitarget stool DNA test) be stopped?

When to Stop Cologuard Screening

Colorectal cancer screening with Cologuard (multitarget stool DNA test) should be discontinued after age 85, with consideration for stopping at age 75 in those with adequate prior screening history.

Age-Based Recommendations for Stopping Colorectal Cancer Screening

General Stopping Recommendations:

• Age 75-85 years: Screening should be individualized based on:

  • Prior screening history
  • Overall health status
  • Life expectancy
  • Patient preferences

• After age 85 years: Screening should be discontinued for all individuals regardless of prior screening history 1, 2

Factors That Influence When to Stop Screening:

Prior Screening History:

• Individuals with negative prior screening tests, particularly colonoscopy, should consider stopping at age 75 1, 3
• Those without prior screening may benefit from screening up to age 85, depending on their health status and comorbidities 1, 3

Life Expectancy Considerations:

• Screening benefits require at least 10 years of life expectancy to realize mortality reduction 2
• Patients with less than 10 years of life expectancy should discontinue screening 1

Comorbidity Status:

• Individuals with severe comorbidities should stop screening earlier, potentially by age 66 4
• Healthy individuals without prior screening may benefit from screening until later ages 4

Special Considerations for Cologuard (Multitarget Stool DNA Test)

Cologuard has specific characteristics that make it less suitable for elderly patients:

• Decreasing specificity with increasing age (only 83% in persons aged >65 years) 2
• Higher false positive rate in older adults 2
• Positive tests require follow-up colonoscopy, which carries higher complication risks in elderly patients 2

Risk-Benefit Analysis

Benefits Diminish with Age:

• Recent evidence shows that among 76-85 year-olds with a negative stool-based test, cumulative colorectal cancer mortality was only 0.33% after 8 years 5
• Death from non-colorectal cancer causes was over 100 times more likely than death from colorectal cancer in this age group 5

Risks Increase with Age:

• Colonoscopy (required for follow-up of positive Cologuard) carries risks including perforation, bleeding, and cardiovascular events 2
• These risks increase significantly with age, particularly after 75 years 2

Algorithm for Decision-Making

1. For patients age 75-85:

   • If patient has had negative prior screening (especially colonoscopy) → Stop screening
   • If patient has never been screened → Consider screening if life expectancy >10 years and good health status
   • If patient has severe comorbidities or life expectancy <10 years → Stop screening

2. For patients over age 85:

   • Stop screening regardless of prior screening history or health status

Common Pitfalls to Avoid

• Continuing screening based solely on patient request without considering harms
• Failing to consider prior screening history when making decisions
• Overestimating life expectancy in elderly patients with multiple comorbidities
• Not recognizing that false positive rates increase with age, leading to unnecessary follow-up procedures

Remember that the primary goal of screening is to reduce mortality and improve quality of life. When the potential harms of screening outweigh the benefits, as is often the case in elderly patients, discontinuing screening is the appropriate clinical decision.