The U.S. is one of only a few countries in the world that relies on colonoscopy as a primary method of screening for colorectal cancer (rather than reserving it for the evaluation of people who test positive on stool-based screenings). I recently wrote a commentary in Medscape about new evidence that supports a continued role for fecal immunochemical testing (FIT) as a colorectal cancer screening test. My article concluded:
When reviewing colorectal cancer screening test choices with patients, family physicians can continue to recommend annual or biennial FIT as a comparable option to colonoscopy. If FIT is selected, we should provide a kit with liquid vial sample collection, if possible, and include a suggested return date in patient instructions. Finally, clinicians in leadership and population health management roles should advocate for cost-effective investments in patient navigation to enhance colorectal cancer screening and diagnostic colonoscopy completion rates, because these initiatives play a crucial role in preventing colorectal cancer deaths.Exact Sciences, which sells a $600 stool-based screening test that combines FIT with a test for colorectal cancer DNA, would like physicians and patients to believe that its test ("Cologuard") provides superior value to practices and health systems than FIT alone. But an analysis published this week in the Annals of Internal Medicine indicates that it does not. Using data from the original Cologuard diagnostic performance study and a study of a second-generation version (Cologuard Plus), Dr. Hermann Brenner and colleagues at Heidelberg University in German showed that the cost per colorectal cancer detected is 7- to 9-fold higher for Cologuard and Cologuard Plus compared to FIT, depending on what percentage of patients undergo colonoscopy after a positive test result.
