What are the next steps after a positive Cologuard (Colon Cancer Screening Test) result?

Next Steps After a Positive Cologuard Test

A positive Cologuard test requires prompt follow-up with a diagnostic colonoscopy within 3 months, but no later than 6 months after the positive result. 1

Understanding the Significance of a Positive Cologuard Result

A positive Cologuard result indicates the presence of abnormal DNA and/or blood in your stool sample, which may suggest colorectal cancer or precancerous lesions. However, it's important to understand:

• Cologuard has a sensitivity of 92.3% for detecting colorectal cancer and 42.4% for advanced precancerous lesions 1
• The test has a specificity of 86.6%, meaning some positive results will be false positives 1
• Of patients with positive tests, approximately:
  • 6% have normal colonoscopy findings
  • 32% have benign conditions
  • 62% have polyps or adenocarcinoma 1

Immediate Next Steps

1. Schedule a consultation with your healthcare provider

   • Discuss the positive result and arrange for a diagnostic colonoscopy
   • This should happen as soon as possible after receiving your result

2. Undergo diagnostic colonoscopy

   • This is the only appropriate follow-up test for a positive Cologuard result 1
   • The colonoscopy should be scheduled within 3 months of the positive result 2, 1
   • Absolutely must be completed within 6 months to avoid increased risk 2, 1

Timing of Follow-up Colonoscopy

The timing of follow-up colonoscopy is critical:

• Evidence shows that delaying colonoscopy beyond 6 months significantly increases:

  • Risk of colorectal cancer (58% higher odds)
  • Risk of advanced-stage disease (116% higher odds) 1

• Research demonstrates a dose-response relationship between delay time and cancer risk:

  • Risk begins to increase after 180 days
  • Risk becomes statistically significant after 270 days (OR: 1.48, CI 1.05-2.08) 2
  • Each additional month of delay increases both CRC incidence and mortality 2

The Colonoscopy Procedure

A diagnostic colonoscopy after a positive Cologuard:

• Requires complete bowel preparation
• Is typically performed with sedation
• Examines the entire colon
• Allows for detection, removal of polyps, and biopsies in a single session 1
• Is the definitive diagnostic test that can visualize and treat precancerous lesions 1

Common Barriers to Follow-up

Be aware of common barriers that may prevent timely follow-up:

• Patient-related factors (49.3% of cases):

  • Lack of understanding about the importance of follow-up 3, 4
  • Fear or anxiety about the colonoscopy procedure 3, 4
  • Declining the procedure (35.2% of cases) 3

• Provider-related factors (16.4% of cases):

  • Inadequate communication about the importance of follow-up 3
  • Technical issues with electronic health record notifications 5

• System-related factors (12.1% of cases):

  • Scheduling difficulties
  • Insurance coverage issues
  • Long wait times 3

Improving Follow-up Rates

To ensure you receive proper follow-up:

• Ask your provider to explain the significance of the positive result
• Request direct referral to gastroenterology services, which has been shown to improve follow-up rates 6
• Address any concerns or fears about the colonoscopy procedure
• Seek assistance with scheduling and insurance coverage if needed

Potential Outcomes of Colonoscopy

Based on colonoscopy findings, your provider will recommend:

• Normal findings: Return to average-risk screening in 10 years
• Polyps found: Follow polyp surveillance guidelines based on number, size, and type
• Cancer detected: Begin appropriate cancer management protocols 1

Important Caution

Follow-up rates after positive stool tests are often suboptimal, with studies showing only 32.8-62.1% of patients completing colonoscopy 3, 7. Don't become part of this statistic - prioritize your follow-up colonoscopy to ensure early detection and treatment if needed.