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Difference between Cologuard and Colonoscopy

Cologuard vs Colonoscopy

Gastroenterology Consultants of San Antonio physicians are seeing an increasing number of patients who have not been appropriately counseled about the pros and cons of various methods of colorectal cancer (CRC) screening. Patients need to understand the limitations and costs of CRC screening tests before making the testing decision with their physician. All GCSA Physicians agree that any CRC screening test is better than doing nothing at all.

In 2014, the U.S. Food and Drug Administration (FDA) approved a non-invasive colorectal cancer screening test that can be done at home and mailed to a lab for analysis. The test, called Cologuard, looks for blood and DNA mutations in your stool that could indicate colorectal cancer.

Cologuard vs Colonoscopy

Here are some facts about Cologuard vs Colonoscopy:

  1. Stool DNA (Cologuard) testing are designed for cancer detection not prevention. Colonoscopy is detection and prevention and only needs to be done every 10 years for cancer-free patients.
  2. Stool DNA (Cologuard) testing has a 12% false positive rate. A positive test requires a diagnostic colonoscopy to remove cancerous polyps.
  3. Screening colonoscopies are not subject to copays and deductibles and usually have no out of pocket costs for patients. Diagnostic testing is subject to deductibles and coinsurance. The 12% false positive rate of Stool DNA (Cologuard) will increase the cost for most patients over the 10-year screening period.
  4. Stool DNA (Cologuard) is not indicated for high-risk patients (family history of CRC, IBD, personal history of polyps) or for those with gastrointestinal symptoms.

For people who are afraid of having a colonoscopy, or who want to avoid the preparation before the procedure, Cologuard is another way to screen for colorectal cancer. However, a colonoscopy is still the best colorectal cancer screening test.

Undergoing a colonoscopy may not be the most pleasant experience one could have, but once it is complete, there is not only a lasting peace of mind, most will not need to have the test performed again for another 10 years. However, due to its inability to detect most high-risk precancers, patients who bypass a colonoscopy for a Cologuard screening will need to repeat the test in just three years.

In short, there is no true replacement for a colonoscopy. Thanks to its overwhelming success rate at detecting colorectal cancer even before it develops, the disease has become one of the most preventable forms of cancer. While other tests such as Cologuard are available and may have some benefits such as requiring minimal preparation and invasiveness, the results provided are less reliable, and patients whose results do indicate a problem will still need to undergo a colonoscopy for confirmation.

GCSA looks forward to continuing to serve our community to help prevent colon cancer – the 2nd most common cause of cancer death in our country, claiming more than 50,000 lives a year. We encourage everyone to make an informed decision for CRC screening with the help of your physician.


Gastroenterology Consultants of San Antonio (GCSA) was established in 1978 and has grown into one of the largest private GI practices in Texas. We have 23 board-certified gastroenterologists on staff, and every single one is dedicated to providing you comprehensive, compassionate and individualized digestive and liver care.

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