Cologuard (Multitarget Stool DNA Test) Age Recommendations for Average-Risk Individuals
Cologuard screening should begin at age 45 for average-risk individuals and continue through age 75, with individualized decisions for those aged 76-85 based on health status and prior screening history, and discontinuation after age 85. 1, 2
Age to Start Screening with Cologuard
Age 45-49 Years
Multiple major guidelines now recommend initiating colorectal cancer (CRC) screening at age 45 for average-risk individuals:
Rationale for starting at age 45:
- Increasing CRC incidence and mortality in younger adults 1
- Approximately 43% of early-onset CRC diagnoses occur in individuals aged 45-49 years 1
- Incidence rates in 45-49 year-olds now match rates previously seen in 50-year-olds when screening was first recommended 1
- Modeling studies show benefits outweigh harms and costs 1, 3
Age to Stop Screening with Cologuard
Age 75-85 Years
- Continue screening through age 75 for average-risk adults in good health with life expectancy >10 years 1, 2
- For ages 76-85: Base decision on:
Age >85 Years
- Screening should be discontinued after age 85 1
- Rationale: Overall mortality risk and adverse events associated with follow-up colonoscopy outweigh potential benefits 1
Cologuard-Specific Considerations
- Cologuard (multitarget stool DNA test) is recommended every 3 years for average-risk individuals 1, 2
- Performance characteristics:
- Sensitivity for CRC: 92.3% (higher than FIT at 73.8%)
- Sensitivity for advanced precancerous lesions: 42.4% (higher than FIT at 23.8%)
- Specificity: 86.6% (lower than FIT at 94.9%) 2
- Any positive Cologuard test must be followed up with diagnostic colonoscopy 1, 2
Special Considerations
- Despite recommendations to begin screening at 45, current uptake remains low - only 19.7% of eligible adults aged 45-49 years were up-to-date on CRC screening in 2021 4
- Screening rates are particularly low among:
- Uninsured individuals (7.6%)
- Those with less than high school education (15.4%)
- Asian Americans (13.1%) 4
- For individuals with family history of CRC or advanced adenomas, earlier screening is recommended (typically age 40 or 10 years before youngest affected relative's diagnosis) 2, 5
Clinical Algorithm for Age-Based Screening Decisions
- Age 45-75: Offer Cologuard every 3 years (or alternative screening method based on patient preference)
- Age 76-85: Assess:
- Prior screening history (negative prior colonoscopy 10+ years ago suggests lower benefit) 6
- Comorbidities (severe comorbidities suggest limited benefit)
- Life expectancy (benefit requires >10 years life expectancy)
- Age >85: Discontinue screening regardless of other factors
Remember that any positive Cologuard test requires follow-up with diagnostic colonoscopy, which carries small but real risks that increase with age.