steph, the problem FIT is always going to have is on the proximal colon. Once the PCP's are educated on this we should be the clear choice provided there are no out of pocket costs.
and the hospitalizations following colonoscopy ... not a huge number statistically however my neighbor passed as a result of an endoscopic procedure on his colon -very rare but it happens as the paper work you sign clearly points out ....
Steph, well documented! In addition, Everyone must remember the vast majority will have a negative CG or negative screening Colonoscopy. The screening tool ,clearly, based on economics and efficacy is going to be CG. The compliance engine will be the genius behind the eradication of CRC
Pill, imo this is about programmatic sensitivity much like the pap virtually eradicating cervical cancer in the screening population. I believe in the 50's cervical cancer was the #2 killer at the time. So it is about getting screened routinely. Unfortunately, millions don't get screened so with a sensitivity of 42.4% for SSL's 1.0 or greater compared to FIT at 5.1% I think this is a no brainer for a PCP to order CG in place of FIT/FOBT. If nothing else to sleep well at night, you sound like you have an understanding of the architecture of the SSL's routinely found on the proximal colon and how easily they are confused with benign lessions. Coupled with the difficulty physiologically some present on the right side. At any rate this test is more about detecting the adenoma's than it is about catching a stage 3 or 4. With a 42% sensitivity for the ssl's every 3 years programmatically should keep more from being diagnosed in the e.r. which is very common in later stage crc. CRC is projected to cost CMS 15+ billion in the next few years annually. So i think the economics support $350-$500 cost. Agreed CG still leads to diagnostic colonoscopy but what a heads up i have as a colonscopist if i'm scoping a CG
positive. It is going to slow me down i'm expecting to find something.
At the end of the day, if you can save CMS 10 billion bucks a year for the next 20 years the economics clearly support the cost of CG
the amazing thing for me is the misinformed docs who read a blurb and then comment like they are experts ... could someone clarify the specificity #'s in the 50-65 year old range? talk about the fastest growing age range in CRC. The growing rate of interval crc and the challenges with the proximal colon and sessile serated lesions. The limitations of FIT/FOBT and what an inflamed colon looks like during colonoscopy. Why all colonoscopists are not created equal and the difficulties with an incomplete prep.
steph, if you had owned shares of amrn back in October you would be shell shocked by the FDA that was my only concern. Amazing, how the parallel review process worked seamlessly- thus far i'm impressed by all involved.
i too spread the word ... but do you take investment advice from a cat driving around in an 01' odyssey?
any article that doesn't mention sessile serated lesions, proximal crc, interval crc and high grade dysplasia in the IBD population is leaving out a bunch of info.
fj, when this is at 25 can i buy your shares for 20 bucks? the GI community will soon understand that the bigger the screening pie the more procedure based endoscopy revenue will come there way. This is a big win win for everyone. Anyone who doesn't want CG to be successful is more about protecting their #$%$ and not about eradicating CRC
Hi mars, and the other part of the story is IBD patients get more Proximal Colon cancers than the the normal population and they are more likely to get CRC at a much earlier age :(. I'm thrilled CG will be available to those at greater risk in developing CRC. Is the study to be completed early 2015?
Hi Cit, I contacted him a bit after he was hired. I was interested in knowing if EXAS was going to initially target OB/GYN's as part of their sales strategy along with the high ordering FIT docs. It always made sense to me because of the corelation with the PAP in terms of programmatic sensitivity, Cin2 and 3 and the testing intervals are similar, etc. He is very very approachable and definitely all about making this launch rapidly successful. i too liked his global background and I see the pattern but something tells this team wants to take this further down the road than most think imo
i'm in at the 3's so far the pundits who have been opining back in the 08'/9s have been spot on ... i get the short thesis ... i'm guessing most shorts have never endured a prep and a day of groggy sedation?
Kirky, are you my good sir writing the SA piece? If USPTF lowers the screening age to 40 which is quite possible, we will see triple digits before 2020. But I will wait in any event :) Cologuard should eradicate CRC in the screening population. Every OB/GYN will be ordering a kit with each pap appointment- programmatic sensitivity is well understood by these specialists. Thanks for the heads up on the article!
agreed and we wouldn't be talking about the false positives if that number had come in at 90% so that 3% can be a host of reasons but i trust the test better than the colonoscopist who may have missed a ssl on the right side or overlooked a 1 cm polyp because of an inadequate prep
this is part of the article that should give pause to anyone who thinks FIT will still be an option
The fecal immunochemical test (FIT) represented an advance over guaiac fecal occult blood testing, and the DNA test has demonstrated the ability to detect more advanced adenomatous polyps and colon cancers as compared with FIT, said Howard Hochster, MD, a GI cancers specialist at Yale Cancer Center. Deciding how to use the test is another issue.
"This test will pick up more colon cancers and adenomas than FIT but also is less [specific], so lower predictive value," said Hochster. "However, it should lead to more colonoscopies for people with large adenomas or actual colon cancer."
He added that the DNA test "should not be used after FIT but instead of FIT."
Mars, good find and probably skewed .... as docs are not too forthcoming when it comes to self reporting their mistakes. The attorney's see to it ....