This is a good review of options from the American College of Surgeons.
Ultimately, for lower risk individuals cologuard/FIT seems sensible, higher risk or easy access and no aversion to a procedure and the cost, go for colonoscopy.
The big issue is getting a sensible test - many individuals will not follow up with colonoscopy, but will send off a stool specimen … so some decent test is better than none.
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I agree with you when I was told to do it… from 50’s up.
I said, no, and i’ve used cologuard (poop and send) now, been 9 years.
I’ve done it three times always double negative.
Cologuard is now the standard way to check colon at our medical school. Covered by insurance… about $500.
Clinic Colonoscopy $5,000… big cost difference.
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The hospital I went to in the USA was about $700-800 USD for a colonoscopy without anesthesia.
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My insurers hate me. I’ve had 3 colonoscopies in 12 years with zero findings (I once said out loud that my mom has a polyp once). Now they’ve said not for 10 years. I think they meant I should just die.
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Yes, that’s the problem.
The prices are all over the place.
Maybe they’re lowering some.There’s so much competition with cologuard. Insurance companies are pushing cologuard because it’s the cheaper route for your health check.
You are allowed to do cologuard once every 3 years. I was one of the earliest patients like number three hundred and fifty or so, and so I’ve actually had it done three times.
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I had 2 where I woke up a lot during the procedure and one where I was out like a dead man. Must have been different drugs. Neither were a problem.
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My insurance covers 92% of the cost for a colonoscopy in Hong Kong. Since they always find polyps, it’s never denied. It costs about 3000-5000 USD with anesthesia in Hong Kong, so about 240-400 USD after insurance with anesthesia. I need one every 2-3 years.
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Everyone should know that you can buy FIT tests OTC for US$22; their overall performance is about as good as the much more expensive first-gen Cologuard, and can be done as often as one wants.
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Price is not the only difference.
FIT looks for traces of blood in stool. Because it only looks for blood, not DNA, there is a higher likelihood of false negatives than with Cologuard, which looks at both blood and DNA. (There will still be false negatives with both, of course.)
Me personally, I’m more concerned with false negatives than false positives, but false postives have their costs, too. What I found (2022 Harvard Health article) is that FIT has a false pos rate of ~5%, where Cologuard has a false pos rate of ~13%.
So there are trade-offs here. Comments from more knowledgeable folks welcome.
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The U.S. Preventive Services Task Force recommends colon cancer screening and is more or less neutral on the method. FIT and the first generation Cologuard (“sDNA-FIT”) give similar performance overall. See their analysis of the benefits and harms of different methods in their systematic review and meta-analysis. And because FIT OTC is so cheap, you can do it as frequently as you like and/or layer it with other tests.
Are you talking about the new cologuard? The FDA has green lit an even better one.
No, I meant the first generation — I didn’t know the second gen had been approved. I’ll edit my second post accordingly. 
Gen 2 is clearly better than Gen 1.
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@RapamycinCurious Actually my bad, next gen is not yet approved/available (but people seem to think it will be soon / for 2025).
Even if it is only marginally effective then it worth doing multiple doses due to the low cost and risk and because it strengthens your immune system against multiple infections.
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