Understanding Your Positive Cologuard Results: When, Why, and How to Take Action

So, you've done the responsible thing. You remembered all those commercials about colon cancer screening, sent away for the Cologuard kit, followed the (admittedly somewhat awkward) instructions, and mailed your sample back. Good for you! Then came the call or letter you weren't expecting: your test came back positive. First things first—take a deep breath. Let's talk about what this actually means and what happens next.

What Does a Positive Cologuard Result Actually Mean?

When you get that positive result, it's natural for your mind to jump straight to the worst-case scenario. But here's the reality check you need: a positive Cologuard test is not necessarily a cancer diagnosis.

What the test actually detected was either blood or abnormal DNA in your stool sample. These could be signs of polyps (growths in your colon) or potentially cancer—but they could also be caused by other factors. This raises an important question many patients ask: are Cologuard tests accurate?

The test is fairly accurate, with a sensitivity rate of 92% for detecting colorectal cancer. However, Cologuard has what's called a "false positive" rate, meaning it sometimes flags an issue when there isn't one. In fact, can Cologuard be wrong? You bet it can. About 13% of people who take the test receive a positive result, but then have no concerning findings when they get their follow-up colonoscopy.

How Are Cologuard Results Reported?

Understanding how Cologuard results are reported can help ease your mind. Your doctor typically receives a simple "positive" or "negative" result from the laboratory. A positive result doesn't provide details about what specifically triggered the positive finding—whether it was blood, DNA markers, or both. This is precisely why a follow-up colonoscopy is essential—to identify exactly what's happening in your colon.

When you receive your results, they won't specify a percentage or probability of cancer. The binary reporting method (positive/negative) is designed to clearly indicate when further testing is needed, without causing unnecessary alarm about cancer probabilities.

The Next Critical Step: Scheduling a Colonoscopy

After a positive Cologuard, the immediate next step is clear: you need a colonoscopy. This leads to a question many patients have: can Cologuard replace a colonoscopy? The simple answer is no—at least not if your Cologuard result is positive.

A colonoscopy is the gold standard for colon cancer screening because it allows your doctor to actually see inside your colon and remove any polyps right then and there. It's both a diagnostic and potentially therapeutic procedure all in one.

Some common thoughts that might be swirling in your head right now:

"But I just did a screening test! Why do I need another one?" Think of Cologuard as the initial alert system—it can tell you something might be off, but can't tell you exactly what that something is. Only a colonoscopy can give you those answers.

"Can't I just repeat the Cologuard to see if it was a mistake?" Unfortunately, no. Once you get a positive result, repeating the test isn't recommended. Moving directly to colonoscopy is the standard of care.

"How urgent is this? Can I wait a few months?" While it's not an emergency that needs attention today, you shouldn't put this off for long. Most doctors recommend getting your colonoscopy within 1-3 months of a positive Cologuard.

How Good Are Cologuard Tests Compared to Other Screening Options?

If you're wondering how good are Cologuard tests compared to other screening options, it's important to understand the benefits and limitations of each.

Cologuard excels at detecting cancer (92% sensitivity) and larger, more advanced polyps (about 42% sensitivity for precancerous polyps). This is significantly better than the older stool tests like FIT (Fecal Immunochemical Test), which primarily detect blood but not DNA markers.

However, colonoscopy remains the most comprehensive option with the ability to detect up to 95% of cancers and large polyps. The key differences are:

• Colonoscopy: Highest detection rate, but more invasive, requires preparation, sedation, and carries small procedural risks.

• Cologuard: Good detection rate, non-invasive, no preparation needed, but can't remove polyps and has higher false positive rates.

• FIT tests: Less sensitive than Cologuard, especially for polyps, but simple to use and can be done annually.

For many people, Cologuard offers an excellent balance of convenience and effectiveness as an initial screening tool. But remember—it's designed to work in conjunction with colonoscopy, not to replace it entirely.

A Brief Background on Colon Cancer Screening

To understand the importance of following up on a positive Cologuard result, it helps to know a bit about colon cancer screening in general.

Colorectal cancer is the third most commonly diagnosed cancer in both men and women in the United States. The American Cancer Society estimates about 106,590 new cases of colon cancer in 2024 alone. But here's the good news: the death rate from colorectal cancer has been dropping for decades, largely due to increased screening.

Screening guidelines have evolved over the years. Currently, most health organizations recommend:

• Starting regular screening at age 45 for people at average risk

• Earlier screening for those with family history or other risk factors

• Various screening options including colonoscopy (every 10 years), Cologuard (every 3 years), or annual FIT tests

Cologuard emerged as a convenient, non-invasive option that helps detect both precancerous polyps and cancer itself. It's a good first-line screening tool, but it was always designed with the understanding that positive results would lead to diagnostic colonoscopies, and only approved for average risk individuals.

What to Expect When You Schedule Your Colonoscopy

Let's demystify the colonoscopy process a bit. Yes, there's prep involved (the infamous clear liquid diet and bowel cleansing), but the procedure itself is typically quick and painless since you're sedated.

The dreaded prep day is admittedly not the most fun 24 hours you'll ever spend, but it's manageable—especially when you consider what's at stake. Most people say the prep is way worse in anticipation than in reality.

As for the procedure itself, you'll be comfortably sedated and typically be in and out within a couple of hours. Most people return to normal activities the next day.

During the colonoscopy, your gastroenterologist will be looking for polyps—growths on the lining of your colon. If they find any (as long as they are not huge), they'll remove them right then, which is one of the major advantages of colonoscopy. Those polyps will be sent to a lab for analysis, and you'll typically get results within a week.

Understanding False Positives: When Cologuard Is Wrong

Since we've established that Cologuard can be wrong, it's worth understanding what might cause a false positive result:

• Recent hemorrhoids or other sources of rectal bleeding

• Inflammatory bowel conditions like ulcerative colitis or Crohn's disease

• Certain medications that can cause gastrointestinal bleeding

• Diet factors (some research suggests certain foods may affect results)

• Other non-cancerous polyps or growths

This is why doctors don't recommend repeating a Cologuard test after a positive result. The colonoscopy will determine whether the positive result was "true" (finding concerning polyps or cancer) or "false" (finding nothing significant).

Remember, even if your Cologuard result turns out to be a false positive, this isn't a failure or a waste—it's the screening system working as designed, being extra cautious about your health.

Possible Outcomes of Your Colonoscopy

There are several possible findings from your colonoscopy:

1. Nothing concerning at all – This happens quite often after a positive Cologuard. Your colon looks healthy, no polyps are found, and you can return to regular screening in 10 years.

2. Non-advanced polyps – Small polyps that aren't concerning but are removed as a precaution. Depending on the number and size, you might need your next colonoscopy in 3-5 years.

3. Advanced polyps – Larger or more concerning polyps that could potentially develop into cancer if left alone. Removing them prevents that progression, and you'll likely need more frequent follow-ups.

4. Cancer – While this is the outcome everyone fears, it's important to remember that even if cancer is found, colon cancer caught early has excellent survival rates. In fact, when detected at local stages, the 5-year survival rate is about 91%.

The vast majority of people with positive Cologuard tests fall into the first two categories. And even those in categories 3 and 4 benefit tremendously from early detection and treatment.

Finding the Right Gastroenterologist Makes All the Difference

The thought of scheduling a colonoscopy might feel overwhelming, but having the right doctor can make the process much smoother. You want someone experienced, thorough, and efficient who can get you in quickly to address your concerns.

Dr. Stuart Akerman is a gastroenterologist who understands the anxiety that comes with a positive Cologuard result. His practice prioritizes patients who need diagnostic colonoscopies, ensuring you don't have to endure weeks or months of uncertainty. With a reputation for both thoroughness and a comforting bedside manner, Dr. Akerman's team handles your case with the attention it deserves.

His office is familiar with all screening methods, including the benefits and limitations of Cologuard, and can thoroughly explain your results and what they might mean in your specific case.

Take Action Now – Your Future Self Will Thank You

If you're reading this with a positive Cologuard result in hand, remember that you've already done the hardest part—you've taken that first step toward protecting your health by getting screened. Now it's time to follow through.

Don't let anxiety or busy schedules delay your next step. A colonoscopy is a small investment of time that could quite literally save your life. Early detection is your most powerful tool against colon cancer, and every day matters.

Call Dr. Stuart Akerman's office today to schedule your colonoscopy. His team understands the urgency of your situation and will work to get you in as soon as possible. Whether your result turns out to be nothing to worry about or catches something early when it's most treatable, you'll gain the peace of mind that comes with taking control of your health.

Remember: a positive Cologuard test isn't the end of the story—it's just the beginning of making sure your story continues for many healthy chapters to come.

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DISCLAIMER: Please note that this blog is intended for Informational Use only and is not intended to replace personal evaluation and treatment by a medical provider. The information provided on this website is not intended as a substitute for medical advice or treatment. Please consult your doctor for any information related to your personal care.