Options after a positive Cologuard test at age 85

Key Points:

• An 85-year-old woman received a positive Cologuard test indicating a 38% risk of advanced polyp and a 4% chance of colon cancer, but her gastroenterologist declined to perform a colonoscopy due to her age and health history.
• The doctor acknowledges the increased risk of complications from colonoscopy in elderly patients, especially those with prior cancer and radiation treatment, and suggests that virtual colonoscopy (CT colonography) may be an alternative, though it can be uncomfortable and may still require follow-up colonoscopy if positive.
• Given the patient's history of multiple CT scans and reassuring blood tests, the likelihood of advanced colon cancer is lower, but the decision to proceed with further testing should consider the patient's willingness to accept risks and potential surgery.
• The article advises patients to discuss with their gastroenterologist whether a colonoscopy would be performed if a virtual colonoscopy shows concerning findings, and to seek a second opinion if there is disagreement about proceeding with invasive testing.
• Ultimately, colonoscopy remains the most definitive test for colon cancer diagnosis and biopsy, but patients must weigh the risks and benefits based on their individual health status and preferences.