Colonox FIT vs Cologuard – Which test should I do?

Colorectal cancer isn’t just an “old person’s disease” anymore—cases are climbing in younger adults, and doctors aren’t entirely sure why. With risks on the rise, screening now starts at 45, giving you a better shot at catching issues early [1].

But choosing the correct colorectal cancer screening test can be daunting. With various options available, it's essential to select a method that aligns with your health needs, lifestyle, and preferences. This article aims to provide clear, accurate information to help you make an informed decision about colorectal cancer screening, particularly the fecal immunochemical test (FIT) vs the Cologuard test.

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Understanding Colorectal Cancer Screening

Colorectal cancer is a significant health concern, ranking as the third most common cancer diagnosed in both men and women [2]. Early detection through regular screening is crucial, as it can identify cancer early or even prevent it by detecting precancerous polyps.

Both FIT and Cologuard are types of stool tests used for colorectal cancer screening. These non-invasive tests analyze stool samples for signs of potential cancer or precancerous growths.

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Fecal Immunochemical Test

FIT is a non-invasive screening tool designed to detect hidden blood in the stool, which can be an early sign of colorectal abnormalities such as polyps, diverticulitis, or cancer [3].

• Procedure: FIT involves collecting a small stool sample at home using a FIT kit. The sample is then analyzed for traces of blood not visible to the naked eye [3].
• Frequency: Annual testing is recommended for individuals aged 45 to 75 [3].

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• Advantages:
  • Accessibility: Over-the-counter availability allows for easy procurement and immediate testing [3].
  • Convenience: The test is simple to perform at home without dietary or medication restrictions [3].
  • Cost-Effective: FIT is relatively inexpensive, with costs typically ranging from $20 to $40 (covered by insurance) [4].

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• Considerations
  • What follow-up does FIT require? A positive FIT result necessitates a follow-up colonoscopy to determine the source of bleeding [6].‍
  • How accurate is a FIT test? While effective, FIT may not detect all cases of colorectal cancer or advanced adenomas, especially those that do not bleed [5].

Cologuard

Cologuard is a stool-based DNA test that detects specific DNA markers associated with colorectal cancer and precancerous lesions, in addition to hidden blood in the stool [7].

• Procedure: Upon physician prescription, a collection kit is mailed to your home. You collect a stool sample and send it to a laboratory for analysis. Results are typically available within a few days [7].
• Frequency: Screening with Cologuard is generally recommended every 3 years for individuals aged 45 to 85 who are at average risk for colorectal cancer [7].  

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• Advantages
  
  • Enhanced Detection: Studies evaluating Cologuard's accuracy show it has a sensitivity of 92% for detecting colorectal cancer, which is comparable to the detection rate of a colonoscopy [8].  
  • Non-Invasive: The test does not require bowel preparation, sedation, or dietary restrictions [7].

• Considerations
  • How much does Cologuard cost? It’s more expensive than FIT, with expenses of around $600 or more [9].  ‍
  • Is Cologuard covered by insurance? Medicare and most major insurers cover Cologuard for eligible individuals, often with no out-of-pocket costs. However, coverage can vary, so it's advisable to confirm with your insurance provider [10]. ‍
  • How accurate is Cologuard? Cologuard has a false-positive rate of approximately 13%, meaning some individuals may receive a positive result without having cancer [11]. ‍
  • What follow-up does Cologuard require? A positive Cologuard result requires a diagnostic colonoscopy, which is covered by Medicare and most commercial insurers without additional cost to the patient [6], [10].

Comparing FIT and Cologuard

When deciding between the FIT test vs Cologuard, consider the following factors:

• Accuracy: So, is Cologuard accurate? It’s better at finding actual cases of cancer but has more false positives, whereas FIT is more accurate in ruling out cancer but might miss some cases [12].  
• Cost: FIT is significantly less expensive than Cologuard, making it a more accessible option for some individuals [4], [9].
• Frequency: FIT requires annual testing, whereas Cologuard is performed every 3 years [3], [7].
• Convenience: Both tests are non-invasive and can be completed at home, but Cologuard requires you to get a prescription and mail the sample to a lab, while FIT is readily available over the counter [3], [7].