Colorectal cancer is the second leading cause of cancer death in the United States. At age 50, it is recommended for those with average risk of colon cancer to get a colonoscopy .
However, a colonoscopy isn’t something most look forward to. But some products claim they can detect colon cancer with a simple test at home.
Chances are you’ve seen the commercial for Cologuard. Analyzing both blood and altered DNA in your stool, Cologuard – a product of Exact Sciences – claims to find cancer and pre-cancer in a stool sample you take at home – it’s not meant to replace colonoscopies.
“Colonoscopies are the preferred way to go at this,” said Dr. Steven Condron with Avera Medical Group Gastroenterology
But Avera Gastroenterologist Dr. Condron says Cologuard is just one more way to get patients screened.
“So trying to get these things off is interrupting the cancer sequence. So I consider colonoscopies cancer prevention as well as detection. Whereas you look at a lot of these tests people are doing like the fit kits or Cologuard, and those are cancer detection. And I think if you can interrupt the sequence prior to it becoming cancerous, you’re ahead of the game,” said Dr. Condron.
President and CEO of Exact Sciences, Kevin Conroy, says Cologuard’s goal is to get more patients screened.
“We know breast cancer screening, about 80% compliance -- cervical cancer screening, about 80% compliance -- colon cancer screening, only about 50% compliance. There’s a huge difference there and the difference is that it’s really hard for some physicians to get their patients to actually get screened. And as a company, Exact Sciences is committed to helping the physician make it a lot easier on getting the patient screened,” said Conroy.
Dr. Karen Simon with Ventura County Gastroenterology in California was an investigator for Cologuard’s clinical study. She explains what happens if the test comes back positive.
“That means it’s very likely that something abnormal is being shed in the stool and that needs to be furthered investigated. So it is recommended that those patients will follow up with a colonoscopy. And if it finds an abnormality or indicates that there’s very likely an abnormality for this patient, it’s going to probably be that much more easy to convince that patient to undergo a colonoscopy,” said Dr. Simon.
“This little thing you’re seeing right here is – blends in very effectively with the underlying colonic tissue. And these things can – the small things can be overlooked and you say ‘well, go ahead and go 10 years; this thing isn’t cancer,’ but it could potentially turn into one in five or seven, 10 years we think,” said Dr. Condron.
Dr. Condron strongly believes getting a colonoscopy is the gold standard in colorectal screening.
“On this part of the colon, the evolving thinking is these things do have cancerous potential down the road -- so we want to get that removed. Certainly doing a test like fecal immunohistochemical testing or the Cologuard would not have found this. The only way we would have ever picked this polyp up is to directly look for it. Even at that, it’s hard to see. Everybody has this idea that this is a scary process. It’s not. You can see, she slept right through it. As long as you’re doing it with somebody who does a lot of them and they’re cared for in the right way, it’s an incredibly safe procedure. But if a patient is hesitant, I have no problem considering a DNA-based test like Cologuard, or fecal immunohistochemical testing, virtual colonoscopy, even a barium enema. I don’t prefer those tests but I certainly would take that over the patient saying I’m just going to wait for there to become a problem,” said Dr. Condron.
Dr. Condron says any screening is better than no screening. But if you do have a history of colon cancer in your family, you are at higher risk of developing colon cancer; tests like Cologuard are only recommended for those with average risk.
Again, age 50 is when you’re supposed to get your first colonoscopy and every 10 years thereafter based on your results. But, if you have a primary relative – mom, dad, brother, or sister who was diagnosed with colon cancer before age 50, it’s recommended you have your first colonoscopy 10 years before their diagnosis. For example, if your father was 45 when he was diagnosed, you should get your first colonoscopy at 35.