Joseph Ferroni, M.D., an obstetrician and gynecologist at Gynecology & Menopause in Philadelphia, Pennsylvania, talks about a new non-invasive colon cancer screening test people can take right at home.
Interview conducted by Ivanhoe Broadcast News in September 2016.
In a nutshell in layman’s terms first of all, what does Cologuard do?
Dr. Ferroni: The Cologuard test is a stool test. It looks for the DNA of polyps, benign precancerous polyps and/or colon cancer. It’s a test that’s done in the home without need for a prep, without need for transportation to and from, without need for anesthesia. It’s really a very good screening test that eliminates all of the negatives that we find with traditional colonoscopy.
How does it compare with the thoroughness, if you will of a colonoscopy?
Dr. Ferroni: The colonoscopy is always going to be the gold standard because that is where the physician, the GI doctor takes a look in there with a scope and can look at every square centimeter of the colon and pick up little tiny polyps or polyps which are going to become possible cancerous in the future. The Cologuard test is strictly a screening test, as well, but it is a test that looks at the antigens that are produced by these polyps and tumors. There’s really no way to compare the two except to say that in testing that has been done Cologuard was well over ninety percent accurate in its detection of polyps or colon cancer.
With your patients when you prescribe this, how receptive are you finding people are and how much in the bigger picture do you think this helps to get more people to get screened, especially those who tend to procrastinate or avoid a full out colonoscopy?
Dr. Ferroni: Patients who are afraid or reluctant to get a colonoscopy or have had one done in the past, it was a very difficult both from a prep point of view and an anesthesia point of view, these are the patients who are more than thrilled to have a test where they don’t have to go through all of that. As far as procrastination goes, a colonoscopy is the gold standard but there is no gold standard if the person just won’t do it. If they will agree to do this test with the understanding that if this test comes out positive then they have to go and get a colonoscopy because if you have the Cologuard done and it comes up positive, it doesn’t tell you really where it is and what to look for. The person will have to do the full prep because there’s no sense in doing a Cologuard if you don’t already agree to the fact that if it’s positive you’re going to go forward and find out why it’s positive.
In other words, if it comes back negative you’re done. If it comes back positive you’re on to the next step?
Dr. Ferroni: Not really you’re done, if it comes out negative, you’re done until the next screening interval which is usually going to be three years or five years. If it’s positive, then that’s when the GI doctor gets involved and say’s ok now we have got to do a full colonoscopy.
What’s the typical patient reaction when you say to them, well you know we have something here that is a step or two short of a colonoscopy as a first step, how do they usually express relief for it?
Dr. Ferroni: It’s usually relief, it’s usually boy that’s great, that’s wonderful. I’ve never wanted to get a colonoscopy or I had it before and I had a terrible experience with it. I’ve been an advocate for so many years of people getting colonoscopy screening that the patients know that this is something they should do.
I mentioned to you that there’s this animation on the Cologuard website, it’s about 30 seconds long and it kind of starts with a picture of the colon and it looks like they are showing animation of polyps and kind of what then is highlighted to use layman’s terms as a result of the Cologuard, if something is found without seeing it just yet we are going to do that after, but walk me through what that process is that’s taking place that enables this to do its job.
Dr. Ferroni: Basically what happens is that when you start to grow a polyp before that polyp becomes cancerous and not every polyp does this of course, it’s only certain types of high risk polyps as that starts to grow it starts to shed its DNA, the cells containing DNA into the stool, so that’s what we are measuring. We’re measuring the DNA of the polyp, now if things had got a little further along and there’s actually a colon cancer brewing that also is producing DNA from the colon cancer that is what makes the test either positive or negative when it goes to the lab.
A couple of other things as far as being a patient is concerned, what was it like for you, now you were already prescribing this to the time you took it or no?
Dr. Ferroni: I had just started prescribing it. I was up to date with my colonoscopy and I was due to get one maybe three years later, when the exact sciences rep came along and said we have this new test, it’s covered by Medicare, it’s covered by a couple of different insurances, would you like to prescribe this to your patients? I’m never the one to jump into something brand new before we have the information on it. What I did was I said, you know what I’ll tell you what, I will do the test myself and we’ll just see how easy it is, we’ll see if insurance covers it, etc. etc. Well I did the test, easiest thing in the world to do and it came back positive. Well, I was fit to be tied. Because I said, I wasn’t going to have a colonoscopy for three more years now. I have to go and get a colonoscopy because your stupid test turned out positive. Well, the stupid test probably saved my life because when I went to see my GI , he said well of course now we have to do a colonoscopy you really were not due for another colonoscopy for another three years because the one you had a few years ago was normal. There were no polyps, he said so maybe we’ll just do a test, maybe we are just reacting to the results of a test but we still have to do it. Of course when I had the colonoscopy done I had developed five polyps; two of which were precancerous, so I don’t know what would have happened in the intervening of the three years, certainly nothing good. I tend to tell people that I think this test is a life saver because I can contest to the fact that believe it either saved my life or it saved me a whole lot of problems in the future.
You say that it’s ninety percent, it’s believed to be about ninety percent?
Dr. Ferroni: Well, it more than that in terms of, if it’s positive or negative. You know having a ninety to ninety-five percent positivity predicted value if the person does have colon cancer, this will pick it up probably about ninety-five percent of the time. When it’s negative you always want to be sure, there are polyps there that maybe were not producing DNA or something like that. This is something where the physician has to get involved with the patient and say okay, this was negative we want to follow-up again with this maybe in three years and that kind of thing to make sure that negative is really negative. But, it’s when one of the positive ones that we’re looking for, that they’re the ones when it’s positive that’s what is going to save lives.
END OF INTERVIEW
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