From the Guidelines
For a 77-year-old male with a history of a 10 mm polyp in the ascending colon 3 years ago, a repeat colonoscopy is recommended over Cologuard for follow-up. This recommendation is based on the most recent and highest quality study, which suggests that individuals with a history of polyps, particularly those with polyps ≥1 cm, are at increased risk for advanced neoplasia 1. The size of the polyp (10 mm) is significant, and according to the NCCN guidelines, a repeat colonoscopy is recommended in 3 years for patients with high-risk polyps, which includes those with polyps ≥1 cm 1.
Key Considerations
- The patient's history of a 10 mm polyp places them at increased risk for advanced neoplasia, making colonoscopy a preferred method for follow-up.
- Colonoscopy offers the advantage of both detection and removal of any new polyps in a single procedure.
- The recommended interval for surveillance colonoscopy after removal of a 10 mm polyp is typically 3-5 years, so the patient is currently within the appropriate timeframe for follow-up.
- While Cologuard is a non-invasive option with good sensitivity for detecting colorectal cancer, it has lower sensitivity for detecting precancerous polyps compared to colonoscopy 1.
- A positive Cologuard test would still necessitate a follow-up colonoscopy, potentially delaying definitive management.
Individual Factors to Consider
- The patient's age of 77, overall health status, life expectancy, and comorbidities should also be considered when making this decision.
- However, based on the history of a significant polyp, colonoscopy provides the most thorough evaluation, and its benefits outweigh the risks in this case 1.
From the Research
Comparison of Cologuard and Repeat Colonoscopy
- Cologuard is a non-invasive, multi-target stool DNA test that has been approved by the FDA for average-risk colorectal cancer (CRC) screening 2.
- Repeat colonoscopy is an invasive procedure that is commonly used for CRC screening and surveillance.
- A study comparing the diagnostic performance of multitarget stool DNA and CT colonography for non-invasive CRC screening found that CT colonography had higher positive predictive values for any neoplasm, advanced neoplasia, and CRC compared to multitarget stool DNA 3.
Considerations for Follow-up
- The patient had a 10 mm polyp in the ascending colon 3 years ago, which increases the risk of developing colorectal cancer.
- A study on fecal DNA testing for CRC screening found that multitarget stool DNA testing had a sensitivity of 92% for detection of CRC, but lower specificity compared to fecal immunochemical testing 4.
- Another study found that a positive multitarget stool DNA test was associated with a higher risk of finding any neoplasia on colonoscopy compared to a positive fecal immunochemical test 5.
Decision Making
- The choice between Cologuard and repeat colonoscopy for follow-up depends on various factors, including the patient's risk profile, preferences, and medical history.
- While Cologuard is a non-invasive and convenient option, repeat colonoscopy may be more effective in detecting and removing precancerous lesions.
- The patient's healthcare provider should discuss the benefits and limitations of each option and make a recommendation based on the individual's needs 6, 3.