Colonoscopy or Cologuard? Which is Best for You?


Colon cancer is the third leading cause of cancer in the United States in both men and women. When identified in the early stages it is curable. But if it has already metastasized, the prognosis is grim. Therefore, screening for colon cancer is vitally important.

If you’re over the age of 50, you’ve probably already had a colonoscopy to screen for colon cancer. But lately, you may have heard about a new screening test, called Cologuard. No unpleasant bowel preparation; no trip to the doctor’s office, no IV sedation, no anesthesia hang-over, no colonoscopy! Sounds great. No more colonoscopy, right?

The Cologuard advertisements report 92% effectiveness in identifying colon cancer. You simply provide a stool sample in the privacy of your home, place it in the kit provided, and mail it in using UPS, shipping costs prepaid. It’s certainly easier than colonoscopy but how does it compare to colonoscopy or other screening methods?

Chris Conover, Duke University economist, recently studied this question for personal reasons and summarizes his findings:

Screening Methods

  • Colonoscopy – the best life expectancy per decade. Required once per 10 years.
  • Cologuard – loses 5.5 – 9.5 days of life expectancy per decade compared to colonoscopy. It is required every 3 years.
  • Sigmoidoscopy – a shorter version of colonoscopy requiring less bowel preparation but still invasive and (hopefully) involving sedation. It is required every 5 years instead of the 10 years for colonoscopy. Statistically, it loses 3.7 – 7.0 days of life expectancy per 10 years compared to colonoscopy.
  • Annual Fecal Tests – These come in two varieties; FIT– fecal immunochemical test and qFOBT– guiac based fecal occult blood test. Either test means 9 more trips to the doctor’s office and loses 3.7 to 6.9 days of life per decade compared to colonoscopy.


Cost Effectiveness

You may not care much about cost-effectiveness but the federal government certainly does. Cologuard is actually the least cost-effective of all the screening methods as this graphic shows:

Cologuard, however, is cost effective when compared to no screening at all. In a recent study, Cologuard cost $923 more per person per ten years than no screening. But it yielded an additional 28.9 days of life expectancy for the average senior. This means the cost per added year of life for Cologuard relative to no screening is $11,639. If Cologuard were the only screening test available, this would be extremely cost effective. But given that there are other screening methods that achieve greater benefits in life-years gained (colonoscopy), Cologuard at its current level of technology and price is actually cost-ineffective.

This tells us that the average ten-year cost of using Cologuard is about $1200 higher than for colonoscopy. Currently, both are available and paid for by most health insurance including Medicare. But if we ever go to a socialized medicine, government-controlled, single-payer system, (like Medicare for All) you can be sure the government will eliminate more costly methods of screening.

For now, the gold standard for detecting colon cancer is colonoscopy every ten years. I’ve done colonoscopy and Cologuard and there is no comparison when it comes to patient convenience and comfort. However, the best recommendation for detecting early colon cancer is both; Cologuard every 3 years and colonoscopy every 10 years. Be happy you have a choice now to do both because the time may come soon when you don’t.


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