Positive Cologuard Test at 85: What Are the Next Steps?

For many older adults, the Cologuard test has become a popular, non-invasive alternative to traditional colonoscopies for colorectal cancer screening. However, receiving a 'positive' result can trigger anxiety and uncertainty, especially for patients in their mid-80s. Dr. Keith Roach, a prominent health columnist, recently addressed this concern, emphasizing that a positive test is not a diagnosis of cancer, but rather a signal that further investigation is required.

When a Cologuard test returns a positive result, it indicates that DNA changes or blood markers associated with polyps or cancer have been detected in the stool. In younger, healthier adults, the standard protocol is an immediate diagnostic colonoscopy. This procedure allows a gastroenterologist to inspect the lining of the colon, identify the source of the positive result, and remove any suspicious growths before they become malignant.

However, for an 85-year-old, the decision-making process is more nuanced. Medical guidelines, including those from the U.S. Preventive Services Task Force, suggest that routine colorectal cancer screening is generally less beneficial after the age of 75 or 85. The decision to screen at this age depends heavily on the individual’s overall health, life expectancy, and personal values regarding medical procedures.

If an 85-year-old patient receives a positive Cologuard result, the primary question for the physician and the patient is: 'Would the findings of a colonoscopy change the patient's care plan?'

Colonoscopies, while generally safe, are invasive procedures that carry risks, particularly for the elderly. These risks include potential complications from sedation or bowel preparation, as well as the rare risk of perforation. If a patient has multiple significant health conditions—such as advanced heart or lung disease—the physical toll of the procedure may outweigh the potential benefits of detecting and treating a slow-growing polyp or early-stage cancer.

Conversely, if the patient is otherwise healthy and active, a colonoscopy might be entirely appropriate. Removing a precancerous polyp can prevent the development of an invasive tumor, which could cause significant health complications and discomfort in the future. In such cases, the diagnostic colonoscopy is not just a screening tool but a preventive health measure that can preserve the patient’s quality of life.

Dr. Roach underscores that the 'next step' after a positive test should be a detailed conversation between the patient, their primary care doctor, and possibly a gastroenterologist. This discussion should cover the patient’s current health status, the risks of the colonoscopy, and the goals of care. There is no 'one-size-fits-all' answer, and a positive result does not automatically mandate an invasive procedure.

For some patients, a 'less-invasive' approach might be preferred, such as a physical examination, blood work to check for anemia, or even a watchful waiting strategy, depending on the severity of the test results and the patient’s health goals. The focus remains on what is most likely to provide the best outcome for the individual, balancing the benefits of early detection against the risks of medical intervention.

Ultimately, a positive Cologuard result at 85 is a call to pause and reassess. It requires an honest evaluation of the patient’s health trajectory and a collaborative decision to either pursue definitive diagnosis or prioritize comfort and quality of life. Patients are encouraged to bring their test reports to their next medical appointment to have this vital discussion about the path forward.