The argument about the best method for colon screening at different ages will continue for a while. How does anyone argue FIT is NOT the preferred method for patients over 75, when the morbidity for colonoscopy is 0.68% vs 0% for FIT. The other age groups have proponents either way and the answers won't be clear for a year or two. FIT will have a prominent place.
But everyone seems to be missing the real use of Cologuard...anemia and occult bleeding workup, especially in the elderly where testing is risky. Don't you really want to know is if the patient's have colon cancer, while you work up the other forms of anemia or microscopic blood loss? How many people taking Eliquis, Pradaxa, and Xarelto as well as coumadin bleed small amounts? When they do bleed a little, is it because they have cancer or is it the medication? What if they have genetic problems taking one or more of the anticoagulant drugs? Carefully monitoring the blood loss might be reasonable until they get their left atrium ablated. It sure beats having a stroke, but colon cancer is worse. So why isn't Cologuard perfect in these patients? Why hasn't anyone talked about it? The market is huge for this use...this is way safer than investigations in people over 75. Is there a conflict of interest because doctors make money from invasive procedures like colonoscopy?