Cologuard Screening Interval After Negative Result
If your Cologuard test is negative, repeat screening in 3 years. 1, 2
Guideline-Based Recommendation
The multitarget stool DNA test (Cologuard) should be repeated every 3 years following a negative result in average-risk individuals. 1, 2, 3 This interval is endorsed by:
Important Context About This Recommendation
The 3-year interval represents a qualified recommendation based on limited long-term data. 1 When the FDA first approved Cologuard in 2014, guidelines explicitly noted "there are limited data available to determine an appropriate interval between screening." 1 The 3-year interval was established based on the test's sensitivity characteristics and modeling studies rather than direct evidence of outcomes at different intervals. 1
Critical Implementation Requirements
You Must Commit to Regular Testing
- Sporadic or one-time Cologuard testing is inadequate and makes stool-based screening a poor choice. 4
- The 3-year interval must be maintained consistently to achieve mortality benefit. 4
All Positive Results Require Colonoscopy
- Any positive Cologuard result mandates immediate follow-up colonoscopy to rule out colorectal cancer or advanced neoplasia. 4, 2
- Cologuard has a 13% false-positive rate (87% specificity), meaning roughly 1 in 8 positive tests will be false alarms requiring colonoscopy anyway. 2
Age-Specific Guidance
Continue Screening Through Age 75
- Repeat Cologuard every 3 years through age 75 if you are in good health with life expectancy greater than 10 years. 2
Ages 76-85: Selective Screening
- Between ages 76-85, continue screening only if you have no prior screening history, good overall health, and life expectancy exceeding 10 years. 2
Stop Screening at Age 85
- Discontinue all colorectal cancer screening after age 85 regardless of prior screening history, as harms outweigh benefits. 2
Comparison to Alternative Screening Options
Colonoscopy Provides Longer Protection
- A negative colonoscopy provides 10 years of protection versus only 3 years for Cologuard. 2
- Colonoscopy uniquely detects AND removes precancerous polyps during the same procedure, directly preventing cancer rather than merely detecting it. 2
Consider Switching to Colonoscopy
- If you find the 3-year Cologuard interval burdensome, colonoscopy every 10 years is the other first-tier screening option with the strongest evidence for mortality reduction. 2, 3
Common Pitfall to Avoid
Do not extend the Cologuard interval beyond 3 years, even if you had a prior negative colonoscopy. While one study suggested that patients with a previous negative colonoscopy who then use Cologuard still detect advanced adenomas at reasonable rates (30% of positive tests), 5 the established guideline interval remains 3 years regardless of prior colonoscopy history. 1, 2