Finally... an easier way to screen for colon cancer has appeared. Finally... is a great word to express a breathy alternative to the dreaded notion of a colonoscopy. Other than a minority of people, most do not revel in the notion of a crampy salty purge followed by a tunnel tubing to a so called sweet spot... the cecum. For those lucky enough to get IV propofol, the "trip" has memorable value. A legal, controlled drug high is always a nice side benefit.
But for most people the idea of being screened for colon cancer is one of dread. But now, with the FDA approval of Cologuard, screening is as simple as submitting a stool sample for DNA analysis. Indeed! While no test, including colonoscopy is 100% of anything, Cologuard picked up about 92% of significant lesions.
The always distasteful issue of cost is a necessary consideration in health care. In the main, pricing in the medical arena is wild west, as has been exemplified by comparing the prices of the same procedure or operation in different markets. Cologuard's cost is not yet set since no insurers have dissected the role of this brand new modality. The manufacturer, Exact Sciences, suggests a price of between $500-600. As opposed to a colonoscopy, with its multiples fees including the gastroenterologist, the facility, the anesthesia, the prep and the pathologist (if biopsies are done), on average the relative difference is impressive.
Naturally the issue will in part be decided on who is the right candidate for Cologuard. Perhaps patients of average risk (no family history of colon cancer) will be targeted. Alternatively, an older population may be better suited for the non-invasive test. The risks of colonoscopy and anesthesia increase with age and the existence of other medical issues such as heart of lung disease. Currently Medicare is pondering the role (if any) of Cologuard.
One clear advantage of Cologuard is that screening will become more accepted. Only about half of Americans submit to screening for whatever reasons. It is reasonable to guess that a non-invasive, less costly and risky alternative will be more widely utilized. To extend that argument, more colon cancer deaths will be prevented with more screening. Consequently we will become a healthier community. Now, sadly, around 150,000 to 200,000 Americans die annually from this malignancy.
Will the number of colonosopies carried out decline? Surely that would be bad news for endoscopists, good news for patients and pocketbooks everywhere. That answer is unknown. At first blush, the simple answer is yes. With further consideration though, the need for colonosopy will rise with so many more patients undergoing screening. Every positive Cologuard test necessitates further investigation. But it matters little about the number of colonoscopies - what matters is health and its maintenance.
There is much left to learn. Who will be the target population for Cologuard? Will high risk patients be included, or those with previous polyps or colon cancers? In the spirit of competition, the notion that declining pricing points for colonoscopy is not out of hand.
No matter the small battles of ultimate implementation, Cologuard is about to change the screening landscape for colon cancer. It is a welcome addition to the progress of Medicine. The soon to be roll out should be interesting.