Colon Cancer Screening

What You Need to Know Beyond the Commercials

There is a nationwide push to increase colon cancer screening — and that’s a good thing. Early detection saves lives. As large healthcare systems promote stool-based tests like Cologuard, it’s important for people to understand the full picture so they can make the best decision for their health.

Many Cologuard commercials don’t emphasize that stool tests can miss cancers and polyps.

Dr. Pou says, “In our clinic, I have seen patients receive a false-negative stool test — meaning the test came back ‘normal’ even though cancer or advanced polyps were present. These delays can allow disease to progress from something curable with a simple colonoscopy to a condition requiring surgery, chemotherapy, or radiation.”

“Even the Cologuard manufacturer notes on their website that false-negatives do occur.”

“This applies to any stool colon cancer screening tool. Including the FIT test.”

Important Insurance Note

Once you choose a stool test like Cologuard and the result is negative, most insurance plans will not cover a colonoscopy as a preventive screening if you later change your mind. Instead, it is usually billed as a diagnostic colonoscopy — which may come with deductibles or out-of-pocket costs.

This surprises many patients.

Key Facts About Cologuard

Cologuard spends millions of dollars advertising the convenience of its colon cancer screening product on TV. While the commercials are entertaining and eye-catching, they gloss over critical details that every patient should understand.

1. Cologuard is not a substitute for colonoscopy.

Colonoscopy is a preventative procedure that removes benign, precancerous polyps before they become cancerous, effectively stopping cancer in its tracks at any age. Cologuard does not remove polyps however; it only detects potential signs of cancer.

2. False positives and false negatives can occur.

• A negative Cologuard test does not confirm the absence of cancer or polyps. This may provide a false sense of security to patients. Patients may still have large polyps, small aggressive polyps, or even early-stage cancer despite a negative result. By the time the patient undergoes another screening, these polyps could progress into advanced cancer, requiring costly and invasive treatments such as chemotherapy, surgery, and hospitalization. Unfortunately, we have seen this happen in clinical practice.

• A positive Cologuard test does not confirm the presence of cancer. Instead, it necessitates a follow-up colonoscopy. Complicating matters, insurance may not always cover the colonoscopy, as some companies consider it a follow-up to an already-paid screening. While insurance rules are supposed to protect patients in these cases, coverage inconsistencies and appeal difficulties remain common.

3. There is ambiguity in positive results.

Cologuard combines two testing methods: one for occult blood and another for DNA markers. A positive result does not specify which test triggered the result, leaving the true cause unclear.

4. True positives often come too late.

By the time Cologuard detects cancer or advanced polyps, “the horse may already be out of the barn,” complicating treatment and increasing costs.

Cologuard Is Not Suitable for Everyone

Cologuard should not be used by patients with:

• A history of adenomas (polyps)
• Inflammatory bowel disease
• Certain hereditary syndromes
• Personal or family history of colorectal cancer

Cologuard is also not evaluated for repeat testing, which raises questions about its long-term reliability.

Colonoscopy: The Gold Standard

While Cologuard and stool tests are better than doing nothing, they are not substitutes for a high-quality colonoscopy.

Colonoscopy remains the gold standard in preventing colorectal cancer.

• Highest accuracy of any screening test
• Detects and removes precancerous polyps in the same procedure
• Actually prevents cancer, not just detects it

If your primary care provider suggests Cologuard as the first option or due to delays in scheduling a colonoscopy, consider requesting a referral to a clinic that performs high-quality colonoscopies, a clinic such as Shenandoah Valley Gastroenterology Center. You have the right to choose the best care.

The Bottom Line

Stool tests can be useful in certain situations, but they are not a substitute for colonoscopy when the goal is the most accurate approach with preventative measures.

Cologuard is not a replacement for colonoscopy. Patients with a positive Cologuard result should always seek a follow-up colonoscopy. A negative Cologuard result may provide a false sense of security.

Colorectal cancer is now the leading cause of cancer-related deaths among men under 50 and the second most common among women in that age group.

If you are 45 or older — or have a personal/family history of polyps — speak with a gastroenterologist about the screening method that gives you the best protection.

A report published by the American Cancer Society in January suggests that rates of colorectal cancer are rising rapidly among people in their 20s, 30s and 40s.

Colon cancer is one of the most preventable cancers we have. Choose accuracy and prevention, not just convenience.

If you are unsure about your options or have concerns about a stool test versus a colonoscopy, consult with a trusted gastroenterology practice like Dr. Pou at Shenandoah Valley Gastroenterology for expert guidance.

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