Colorectal cancer screening: colonoscopy vs. Cologuard

When COVID-19 hit, routine cancer screenings nearly came to a halt. Now those postponed appointments and overdue tests will likely result in delayed cancer diagnoses.

Now more than ever it’s an opportune time to educate the community about the importance of regular cancer screenings. While we have powerful treatments for those diagnosed with cancer, nothing is more powerful than prevention or early detection.

Colorectal cancer is the second leading cause of cancer-related death, according to the Centers for Disease Control and Prevention. We know that routine screening is unequivocally the best way to prevent this disease.

The two most common screening tests patients can undergo to check the health of their colon and rectum are conventional colonoscopy and the Cologuard study.

During a colonoscopy, your doctor uses a thin, flexible camera to check for abnormalities or disease in your lower intestine or colon.

The primary advantage of doing a colonoscopy is that if the doctor finds polyps (precancerous tumors) they can remove or biopsy them at that time. This can effectively treat the polyps and allow them to be evaluated (biopsied).

We recommend that the average-risk patient be screened every 10 years starting at age 50, unless they have a family history of colorectal cancer or polyps, or develop symptoms in between screenings. Other at-risk patients include those who suffer from certain digestive diseases, such as inflammatory bowel disease (ulcerative colitis or Crohn’s Disease) or Type II diabetes.

Often times, individuals view a colonoscopy as inconvenient due to the invasive nature of the procedure, bowel preparation, and time required off of work. However, after undergoing the procedure most people tell me it wasn’t as bad as they had anticipated.

The other common option for screening is Cologuard, a do-it-yourself, mail-in test, which identifies abnormal DNA and traces of microscopic blood that precancerous polyps and colorectal cancer can cause.

Cologuard has recently gained popularity, as it’s less invasive and more convenient than a traditional colonoscopy. This test is best for individuals who have an average risk for colon cancer (in other words, no family history of colon cancer or polyps) and no symptoms.

There are certainly some benefits to the Cologuard test, but there are drawbacks, too, including concerns about accuracy. False positives frequently occur in Cologuard tests – meaning the test may be positive when indeed there is nothing wrong.

If a Cologuard test is positive, it prompts a colonoscopy to evaluate the colon for possible polyps or cancer.

It is important to talk to your primary care doctor to determine the screening test that’s right for you. Either way – please be proactive about your health. Any screening is better than no screening at all.