# Anyone use Cologaurd? **URL:** \ **Category:** In My Humble Opinion\ **Created:** [December 10, 2016, 2:50am UTC](https://boards.straightdope.com/t/anyone-use-cologaurd/774321 "2016-12-10T02:50:49Z")\ **Posts on this page:** 10\ **Page:** 2
**Author:** ![LSLGuy](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/lslguy/32/5813_2.png) [@LSLGuy](https://boards.straightdope.com/u/LSLGuy)\ **Post date:** [December 13, 2016, 3:33pm UTC](https://boards.straightdope.com/t/anyone-use-cologaurd/774321/21 "2016-12-13T15:33:02Z")
Thank you. Missing 30% of high grade dysplasia is (or ought to be) a deal killer. It’ll certainly be a patient killer. A side question for which there’s probably no data is whether the misses are a result of genetic diversity in the lesions or a result of just non-uniform distribution of lesion markers in fecal samples . IOW … Imagine we have a subject who we knew via colonoscopy had significant lesions. Now we give them the test once and it comes back clean. Would rerunning the test, say, weekly keep missing the problem every time since the screen isn’t sensitive to whatever markers that particular patient+lesion is throwing? Or would we see hit or miss detection based on the luck of whether there’s enough lesion marker present in the sample to be detected? There’s an implicit assumption in most medical testing that the Principle of Mediocrity applies: samples are uniform (enough). Pretty good bet for a CBC. But are they in this case? At $600 a pop it’s obviously not going to be repeated often in the clinic. The point of the experiment above would be for the manufacturer to learn how it’s failing and therefore how it ought to be improved. In principal the test’s sensitivity can be turned up, at the cost of creating even more false positives. But if there’s huge variation in actual factual signal from sample to sample then that’s not the right solution. The right solution for that would be more and larger samples homogenized before processing. Again not that I expect you (or anyone) can explicitly answer the question. Just musing on the issues inherent in this kind of testing. ---
**Author:** ![kayaker](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/kayaker/32/441_2.png) [@kayaker](https://boards.straightdope.com/u/kayaker)\ **Post date:** [December 13, 2016, 5:30pm UTC](https://boards.straightdope.com/t/anyone-use-cologaurd/774321/22 "2016-12-13T17:30:15Z")
> [@Roderick\_Femm](#): > > My doctor wants me to have another colonoscopy next year (it will have been 10 years since the last one, squeaky clean by the way). **I’m hoping to persuade him to allow this instead.** (bolding mine) Is this really your attitude wrt healthcare? If I felt a particular approach was how I wanted to go (after careful study and consideration), and my doctor said no, I’d find a doctor who would do what I wanted. ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [December 14, 2016, 1:48am UTC](https://boards.straightdope.com/t/anyone-use-cologaurd/774321/23 "2016-12-14T01:48:05Z")
> [@LSLGuy](#): > > … Would rerunning the test, say, weekly keep missing the problem every time since the screen isn’t sensitive to whatever markers that particular patient+lesion is throwing? Or would we see hit or miss detection based on the luck of whether there’s enough lesion marker present in the sample to be detected? > > There’s an implicit assumption in most medical testing that the Principle of Mediocrity applies: samples are uniform (enough). Pretty good bet for a CBC. But are they in this case? … You are 100% correct that the question is a good one and that there is no basis that I know of for an informed answer. So, for example, from [a 2008 evaluation of test strategies](http://annals.org/aim/article/743580/evaluating-test-strategies-colorectal-cancer-screening-decision-analysis-u-s): > [@](#): > > We found that colorectal cancer screening with highsensitivity > FOBT (Hemoccult SENSA or fecal immunochemical > test) provided similar life-years gained as colonoscopy, > even though the individual test characteristics were > substantially better for colonoscopy (Table 2). This finding > was partially due to the fact the FOBT must be performed > every year compared with every 10 years for colonoscopy, > and **the test characteristics are assumed to remain unchanged > with each subsequent screening**. For example, if > an adenoma was missed by a screening test in one cycle, > then the chance that it would be missed again on the next > examination is still based on the false-negative rate (1 – > sensitivity for adenomas). **There is little evidence on > whether test sensitivity varies with increasing rounds of > testing**. In addition, a substantial percentage of individuals > receiving annual FOBT screening will eventually have a > false-positive screening result with referral for colonoscopy. > Once confirmed to be negative by colonoscopy, they then > have colonoscopy screening every 10 years, as per guidelines. > For example, with a specificity of 92.5% for Hemoccult > SENSA, the percentage of people in a colonoscopy > screening program is about 54% after 10 FOBTs and > about 79% after 20 FOBTs. Bolding mine. ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [December 14, 2016, 1:51am UTC](https://boards.straightdope.com/t/anyone-use-cologaurd/774321/24 "2016-12-14T01:51:02Z")
> [@kayaker](#): > > (bolding mine) > > Is this really your attitude wrt healthcare? > > If I felt a particular approach was how I wanted to go (after careful study and consideration), and my doctor said no, I’d find a doctor who would do what I wanted. Would this be your attitude with regard to tax law guidance? If you felt a particular approach was how you wanted to go (after careful study and consideration), and your tax lawyer said no, would you go and find a tax lawyer who would do what you wanted? ---
**Author:** ![kayaker](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/kayaker/32/441_2.png) [@kayaker](https://boards.straightdope.com/u/kayaker)\ **Post date:** [December 14, 2016, 11:56am UTC](https://boards.straightdope.com/t/anyone-use-cologaurd/774321/25 "2016-12-14T11:56:16Z")
> [@DSeid](#): > > Would this be your attitude with regard to tax law guidance? > > If you felt a particular approach was how you wanted to go (after careful study and consideration), and your tax lawyer said no, would you go and find a tax lawyer who would do what you wanted? No, but I could see how someone could choose to do so. My accountant will sometimes alert me to situations where there is ambiguity in tax matters. We have an understanding that I’d rather avoid risk in these situations. As far as health matters are concerned, I’m more interested in quality of life rather than quantity. I understand people differ on this. ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [December 14, 2016, 12:29pm UTC](https://boards.straightdope.com/t/anyone-use-cologaurd/774321/26 "2016-12-14T12:29:17Z")
I have little understanding of tax law, perhaps you have little understanding of how QALY is calculated and how the outcomes, in terms of quality of years lived, are used as part of determining effective screening strategies and recommendations? ---
**Author:** ![kayaker](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/kayaker/32/441_2.png) [@kayaker](https://boards.straightdope.com/u/kayaker)\ **Post date:** [December 14, 2016, 1:06pm UTC](https://boards.straightdope.com/t/anyone-use-cologaurd/774321/27 "2016-12-14T13:06:14Z")
I have zero understanding of tax law. 🙂 I put total trust in my accountant. I’m pleased with the results to date. For medical issues I research and come to conclusions based on how choices impact _me_. If all I wanted was to be maximally healthy, I wouldn’t drink as much as I do. I’d either stop consuming cannabis, or I’d at least not combust and inhale it. I’d stop eating the foods I love that are on the “absolutely not” gout list. Yet I’m happy as a clam. ---
**Author:** ![kayaker](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/kayaker/32/441_2.png) [@kayaker](https://boards.straightdope.com/u/kayaker)\ **Post date:** [December 14, 2016, 1:08pm UTC](https://boards.straightdope.com/t/anyone-use-cologaurd/774321/28 "2016-12-14T13:08:50Z")
> [@DSeid](#): > > I have little understanding of tax law, perhaps you have little understanding of how QALY is calculated and how the outcomes, in terms of quality of years lived, are used as part of determining effective screening strategies and recommendations? Understand I’m not arguing for/against any particular test. I’m just uneasy thinking that a patient would accept as gospel whatever a healthcare provider’s point of view happens to be. /hijack. ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [December 15, 2016, 2:54am UTC](https://boards.straightdope.com/t/anyone-use-cologaurd/774321/29 "2016-12-15T02:54:22Z")
Of course this a hijack, but the actual op has been pretty well covered so what the hell. The ideal, for tax advice and for medicine, is not to accept anything as Gospel, but to work in a partnership with an expert that you trust. I find it humorous that many who would never consider doing an hour or so of google research and then presenting to an expert tax advisor with a demand of “do this” and if they say “no, I won’t because that is, for you and your circumstance, in my expert opinion, a horrible idea that exposes you to more risks than benefits”, then saying “then buh-bye, I’ll find someone who will.” - feel somehow that they _should_ do that in regards to their healthcare. From the provider side my job should include discussing a range of reasonable options and, dependent upon the patient’s (or patient’s family in my case often as a pediatrician) interest, going over some of the pros and cons of the options and how they may play into the specific circumstances of the individual. My job is not to prescribe or order the patient or their family an option that is not in my opinion a reasonable option for them because they say they want it based on what they googled. I get that you want to drink however much you want, smoke as much pot as you want, eat whatever you want however much you want, and consequences be damned, you are enjoying it. Not sure that you really though want a doc who would help you do that. Heck I get that a cigarette smoker may want to keep smoking and that a meth-head may not want to quit either. Not the doctor’s job to help them though. No idea how much you drink, if your pot habit impairs your daytime function, or what you eat in what quantities. Not my concern. Could all be quite moderate and at levels of no serious health concern or even in some cases of possible benefits. Don’t know don’t care. But if you have a good doctor and a good relationship with that doctor, then it is that doctor’s concern. And in the case of someone whose habits _are_ significant health risks that doctor has an obligation to make sure that the individual understands what those risks are, risks that usually are less so shortened lifespan than decreased quality of life for more of the years alive, with much higher risks of dementia, other cognitive disabilities, and of early onset of physical disabilities. It is that doctor’s proper place to try to help the individual understand that more quality of life for longer means modifying some habits to some degree and to help the individual find the tools to implement any changes they decide to make. Usually making that case is easiest if there is the perception of a partnership between patient and provider, IMHO. If that is the sort of doctor you want to avoid then no problem. Usually _those_ docs are busy enough without your business. ---
**Author:** ![teela\_brown](https://avatars.discourse-cdn.com/v4/letter/t/d9b06d/32.png) [@teela\_brown](https://boards.straightdope.com/u/teela_brown)\ **Post date:** [December 15, 2016, 11:24pm UTC](https://boards.straightdope.com/t/anyone-use-cologaurd/774321/30 "2016-12-15T23:24:15Z")
This is off-topic, but it’s a good thread to link it in. The same team (Mayo Clinic researchers and Exact Biosciences) that patented the test discussed above has just patented a [similar process for the detection of pancreatic cancer](http://tcbmag.com/News/Recent-News/2016/December/Mayo-Researchers-Land-Patent-For-Non-Invasive-Panc). It uses some of the same technology and it’s showing good promise, though it’s too early to get too excited. I’m crossing my fingers, because pancreatic cancer is especially horrible. [Previous page](https://boards.straightdope.com/t/anyone-use-cologaurd/774321.md?page=1)