How Medically Favorable Is the Replacement of the Invasive Colonoscopy With Cologuard Non-Invasive Colorectal Cancer Screening?

Abstract

In 2014, the FDA approved the non-invasive and economical Cologuard test for colorectal cancer diagnosis for people reaching the age of 50, a milestone previously met with the “gold standard” of colorectal cancer diagnosis: the colonoscopy. Though prevention and treatment for the third most common cancer in the world have been heavily researched, the diagnosis has been thought to be set with the colonoscopy, without much room for modifications. To assess the possibility of replacing the invasive and costly colonoscopy with Cologuard screening as the first step in colorectal cancer diagnosis, a retrospective cohort study was done with data collected from a medical health record database of a northeast Ohio hospital. Medical record numbers were matched with age, sex, any personal or family history, and the results of the colonoscopies of 111 patients with positive Cologuard tests. Of the 111 patients, 92 proceeded with the colonoscopy. The sensitivities, or true-positive rates of results, were calculated for groups organized with respect to age, sex, and previous family and personal oncologic history. Since the data is categorical, a goodness of fit chi-square was done for the statistical analysis, resulting in a failure to reject the null hypothesis with χ2=0.09318 and p=6.571. In conclusion, the replacement of the invasive colonoscopy with Cologuard non-invasive screening as the first step in colorectal cancer diagnosis could not be proven statistically significant and, therefore, medically favorable.