A cancer trend moving in the wrong direction
Colorectal cancer (CRC) screening isn’t only a clinical priority for health systems; it’s also tied directly to capacity planning, quality performance, and cost of care. Colorectal cancer is widely recognized as one of the more preventable cancers, yet screening completion continues to lag behind other cancer types.1 It’s now the leading cause of cancer death among adults younger than 50, a reversal from the early 1990s, when it ranked fifth.2 That shift matters because the disease is largely silent in its early stages, so screening, rather than symptoms, is often what catches it in time.3 Stage at diagnosis is an important predictor of survival: five-year survival is 91% for patients diagnosed at the localized stage, 73% at regional spread, and just 13% once the disease has spread further.4 For health systems, that gap is also an operational and quality-measure challenge. Despite staffing and capacity constraints, the tools to help close this gap already exist. The challenge is getting more patients through screening earlier.
Directing colonoscopy to patients who test positive
Many health systems are approaching CRC screening differently by starting with a noninvasive, at-home collection kit and reserving colonoscopy for high-risk patients and patients who test positive.5 This approach may help prioritize colonoscopy resources toward patients with a positive screening result who require follow-up colonoscopy, rather than spreading it thin across an entire eligible population.6 It also tends to work better in practice: patients who discuss screening options with a clinician, rather than being routed straight to colonoscopy, complete screening at three times the rate.7
Capacity can’t keep pace
This approach matters because health systems are navigating significant capacity and resource pressures, making these constraints very real. An estimated 60 million average-risk Americans are eligible for CRC screening.8 Referral to colonoscopy doesn’t guarantee follow-through: a substantial share of patients referred by their primary care physicians never complete the procedure.9 Guidelines now recommend average-risk screening begin at 45 instead of 50, expanding the age-eligible population.5,10 When capacity is limited relative to the population that needs to be screened, health systems must navigate both patient follow-through and the screening completion rates reflected in quality and value-based performance measures.
Where the Cologuard Plus® test fits
Solving this problem requires more than directing colonoscopy to patients who test positive. It starts with identifying eligible patients and offering a first-line test health systems can trust: one that performs reliably, helps patients complete follow-up care when needed, fits into existing workflows without a new technology lift, and holds up under the quality measures systems are already held accountable to. The Cologuard Plus® test meets each of those conditions. In its pivotal BLUE-C study of more than 18,900 average-risk adults, it demonstrated 95% sensitivity for colorectal cancer and 91% specificity.11
This approach only works if patients who screen positive actually complete a follow-up colonoscopy, which is where referral-based approaches tend to lose patients.9 A noninvasive stool-DNA test performs differently on that measure. Patients who screen positive complete follow-up colonoscopy nearly twice as often as those who screen positive on a fecal immunochemical test (FIT): 85% versus 43% within six months.12 Follow-up is also faster, averaging 86 days compared with 127 days for FIT.13 The test also integrates into existing electronic health record (EHR) workflows, including Epic-based tools, without a new informatics build.11 It carries 3 years of Healthcare Effectiveness Data and Information Set (HEDIS®) screening credit, compared with 1 year for FIT, an important consideration for health systems focused on screening completion and quality and value-based performance.14,15
What the shift has produced in practice
Geisinger Health raised its CRC screening rate to 70% by making the original Cologuard® test its first-line option; Sanitas Medical Center saw a 111% increase over four years doing the same.16,17 These results were achieved with the earlier-generation Cologuard® test, prior to Cologuard Plus®; the two tests share the same at-home, stool-based approach, but these specific percentages should not be read as native to Cologuard Plus®. Both results reflect the impact of a different screening strategy, not additional capacity.
Supporting earlier detection, without added complexity
No symptoms doesn’t mean no risk of colorectal cancer.3 A patient caught at stage one instead of stage three helps avoid the most advanced, most resource-intensive course of care. That is a better outcome for the patient, and it is also a lighter burden on the system responsible for their care. For average-risk patients, leading with the Cologuard Plus® test supports that kind of earlier detection at scale, for more patients, without requiring added cost or infrastructure.
The Cologuard® and Cologuard Plus® tests are intended to screen adults 45 years of age and older who are at average risk for colorectal cancer by detecting certain DNA markers and blood in the stool. Do not use Cologuard products if you have had a personal history of colorectal cancer or precancerous polyps, have inflammatory bowel disease, a family history of colorectal cancer, or certain hereditary syndromes, or a positive result from another colon cancer screening method within that test’s recommended screening interval. Talk to your healthcare provider if any of these situations apply to you.
Cologuard results should be interpreted with caution. A positive test result does not confirm the presence of cancer. Patients with a positive test result should be referred for colonoscopy. A negative test result does not confirm the absence of cancer. Patients with a negative test result should discuss with their doctor when they need to be tested again. False positives and false negative results can occur. Rx only.
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13. Kowalkowski H, Austin G, Guo Y, et al. Patterns of colorectal cancer screening and adherence rates among an average-risk population enrolled in a national health insurance provider during 2009-2018 in the United States. Prev Med Rep. Available online November 10, 2023. doi:10.1016/j.pmedr.2023.102497.
14. National Committee for Quality Assurance. (2016, October 6). NCQA updates
HEDIS measure for colorectal cancer screening. Healio.
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16. Exact Sciences Corporation. (2022). Data on file for Geisinger case study. Health System Marketing.
17. Exact Sciences Corporation. (2023). Data on file for Sanitas case study. Health System Marketing.
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