Offering Cologuard increases colonoscopy at USMD Health System

Colon cancer screening is effective in finding precancerous polyps and reducing the incidence of colon cancer in the Unites States. The USPSTF recommendations for colon screening include stool testing for occult blood (hemoccult or fecal immunochemical testing), sigmoidoscopy, or colonoscopy.1 Colonoscopy is considered the "gold standard" for colon cancer screening. However, up to 30% of United States adults over age 50 are not compliant with colon cancer screening. Some patients just refuse colonoscopy. Giving patients a menu of options can increase colon screening.2

USMD Inc., an integrated health system, is focused on preventative care to improve population health. USMD promotes screening colonoscopy as the preferred method of colon cancer screening. However, patients who refuse to have a colonoscopy frequently refuse to collect stool samples for occult blood testing. USMD decided to offer Cologuard to patients who refused colonoscopy.

Cologuard® is a non-invasive screening test for stool DNA associated with colon cancer, is FDA approved, and is covered by Medicare. Published results from a 10,000-patient clinical trial, Cologuard found 92% of cancers, 42% of precancers.3 Over the course of one year at USMD, 460 Cologuard were ordered. A positive Cologuard® should be followed by a diagnostic colonoscopy.

Cologuard® testing increased colonoscopy. 52 patients underwent a colonoscopy as a result of a positive Cologuard. Again, these patients had refused a colonoscopy previously. 52 additional colonoscopies resulted from ordering 460 Cologuard (11.30%). Based on these results, ordering Cologuard on a theoretical population of 10,000 patients could result in 1130 additional colonoscopies.

In summary, our real world experience demonstrates offering Cologuard to patients who previously refused a colonoscopy resulted in an additional 52 colonoscopies.

1. U.S. Preventive Services Task Force. Screening for colorectal cancer: U.S. Preventive Services Task Force recommendation statement. Annals of Internal Medicine 2008; 149(9):627-637
2. Inadomi JM et al. Arch Intern Med. 2012:172(7):575-582.
3. Imperiale T.F., Ransohoff D.F., Itzkowitz S.H., et al. N Engl J Med 2014; 370:1287-1297

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