02/08/2026
COLOGUARD (p**p in a box): Not a great choice for the first colorectal cancer screen
Understanding the shortcomings of Cologuard for colon cancer screening
Many people who have reached the age of 45 are using the Cologuard test for colon cancer screening instead of undergoing colonoscopy. Some do this by choice, others by the recommendations of their primary medical doctors, and many because they receive a kit in the mail from their insurance.
The Cologuard test is a noninvasive, at-home stool-based screening for colorectal cancer that detects altered DNA and blood. It is approved for average-risk individuals aged 45 or older, and a positive result requires a follow-up colonoscopy. The process involves receiving a kit, collecting a sample at home with no special preparation, and shipping it to a lab for analysis.
What they don’t tell you is that it misses many precancerous polyps (57% vs 5 % for colonoscopy), and a good deal of cancer (7-8% vs less than 2-3 % with a properly performed colonoscopy).
The reason Cologuard is being recommended by internists is not for your best interests, but rather to save money for the insurance companies. Many of the managed health plans encourage the primary doctor not to utilize specialty care with monetary incentives. In addition, once Cologuard is used with the colon cancer screening diagnosis code, which most of the time waves your deductible, you can not use that code again if you decide afterward that you want a colonoscopy. The deductible would then come into play.
Colonoscopy remains the gold standard for colon cancer screening, with the highest sensitivity and specificity for finding polyps and cancers, and the lowest false negative rates, when done by a competent Gastroenterologist, with a good colon preparation.
As the patient gets older, or has had at least 2 negative colonoscopies, Cologuard becomes a more viable option, but to take the risk of missing cancers and polyp, at a young age, with your first screen, is taking unnecessary risk with the second most common cancer in both men and women. If not wanting to have a colonoscopy is due to the fear of the preparation, please refer to my blog on the art of colonoscopy.
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