Gastroenterologists: 'Choose science over convenience' in colonoscopy, Cologuard debate

Gastroenterologists criticized the effectiveness of Exact Sciences' Cologuard in opinion pieces in STAT and the Peoria Journal Star, but still recommend it to patients as a second-tier option.

Physicians highlighted the test's limitations, while acknowledging its value as an alternative to non-high risk individuals. 

Here's what you should know:

1. According to an Exact Sciences-funded study published in the New England Journal of Medicine, Cologuard detects 93 percent of cancers found through screening colonoscopy.

2. Ypsilanti, Mich.-based Huron Gastroenterology's Research Director Naresh Gunaratnam, MD, told STAT he takes issue with that detection rate. Although 93 percent is a "great result," the 7 percent of missed cases, could translate to one out of 13 people having undetected colon cancer, he said. More than a million patients have used the test.

3. Dr. Gunaratnam recommends physicians follow the Multi-Society Task Force's 2017 recommendation to view the test as a second-tier option if patients decline both colonoscopy and FIT testing.

4. Dr. Gunaratnam said, "Someday we may have a simple blood, saliva or stool test that can detect colorectal cancer and polyps better than colonoscopy. … When that day arrives, I will prescribe that new screening test because the science is sound and it is in the best interest of my patients. Until then, I will counsel physicians and their patients to choose science over convenience. That choice should be screening colonoscopy, the only test that can both detect and prevent colorectal cancer."

5. Peoria-based Illinois Gastroenterology Group gastroenterology Eli Kuga, MD, shared his thoughts on Cologuard with the Peoria Star. Like Dr. Gunaratnam, Dr. Kuga took issue with Cologuard's miss rate. Colonoscopy is a first-line recommened treatment with a 95 percent national standard completion rate, according to a New York Times article.  

6. He said Cologuard is better than no screening at all, but colonoscopy is the gold standard in CRC-detection testing.

Note: Exact Sciences did not respond to a request for comment before publication. This story will be updated upon receipt.

Note: This story was updated Sept. 28. 

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