What is the recommended screening interval for Cologuard (multitarget stool DNA test) in an average-risk adult over 50 with no family history of colorectal cancer?

Cologuard Screening Interval

The recommended screening interval for Cologuard (multitarget stool DNA test) is every 3 years in average-risk adults aged 45-75 years. 1

Screening Interval Recommendation

• Cologuard should be performed every 3 years as specified by the American Cancer Society guidelines for average-risk adults beginning at age 45 (qualified recommendation) or age 50 (strong recommendation). 1

• The U.S. Multi-Society Task Force on Colorectal Cancer endorses the same 3-year interval for multitarget stool DNA testing. 2, 3

Important Context About Test Positioning

• Cologuard is classified as a second-tier screening option behind colonoscopy every 10 years and annual FIT, which are the first-tier cornerstone tests with the strongest evidence base. 2, 3

• The sequential screening approach should prioritize offering colonoscopy first, then annual FIT, then Cologuard every 3 years to patients who decline the higher-tier options. 2

Critical Follow-Up Requirements

• All positive Cologuard results mandate timely diagnostic colonoscopy as an essential part of the screening process—this is non-negotiable. 1, 4

• Cologuard has a 13-40% false-positive rate (87% specificity), which is lower than FIT's 95% specificity, leading to more unnecessary colonoscopies. 2

Age-Specific Guidance

• Begin screening at age 50 for average-risk adults (strong recommendation) or age 45 (qualified recommendation based on modeling studies showing rising CRC incidence in younger adults). 1

• Continue screening through age 75 in adults with good health and life expectancy >10 years. 1

• Stop screening at age 75 in patients up-to-date with prior negative screening, or when life expectancy is <10 years regardless of age. 1, 4

Common Pitfalls to Avoid

• Never use Cologuard in symptomatic patients with rectal bleeding, unexplained weight loss, or narrowed stools—these patients require immediate diagnostic colonoscopy regardless of any stool test results. 4

• Do not screen patients with family history of CRC, inflammatory bowel disease, or personal history of polyps/CRC, as these are high-risk populations requiring colonoscopy, not average-risk screening tests like Cologuard. 1

• Ensure colonoscopy capacity exists in your practice before ordering Cologuard, as positive results require follow-up colonoscopy. 4