Cologuard by Exact Sciences
by Anonymous Questions | October 27, 2014 1:49 pm
from morning news about new colon cancer dna test called cologuard by exact sciences mkt. cap $1.95B. Missed Oct. earnings, Down 1.3% premkt. Any information? What may be yours and Dr.Kss and Blind squirrels thoughts. signed an Avid follower. and of course many many thanks
Source URL: https://www.stockgumshoe.com/2014/10/microblog-cologuard-by-exact-sciences/
The only analysis I’ve read recently on EXAS was negative, the short argument made by Whitney Tilson and others, and I know Dr. KSS has been negative on the viability of the company’s colon cancer test in the past. Part of the short argument was that the reimbursements couldn’t possibly be high enough for their Cologuard test to make them a profit, since the competing test is similarly effective and is extremely cheap (part was also that the patient’s task with cologuard is much “grosser” than with the standard test).
Part of that short argument took a hit a couple weeks ago when the reimbursements came out better than expected, so that’s what’s keeping the stock pretty elevated here — the small drop on earnings is backward-looking, seems to me that investors are very focused on the future with increased cologuard usage (and higher reimbursement) still. Haven’t read the company’s commentary and I’m not terribly interested in this one, despite my strong interest in colon cancer detection and prevention (family history) — I hope it helps, but most people I read don’t seem to think it really will be substantially better than existing screening, or get through to the people who are now unscreened.
That’s just my thoughts. The company is not expected to be profitable for a couple years, current earnings are pretty meaningless and revenues are tiny until Cologuard really ramps up (if it does) — just try to understand what you think the market really is and what share of it they can take, and how long it will take to get there, that’s probably what analysts are doing.
Medicare will pay for it (cologuard)
Yeah, for now….till they realize how much, how many billions of dollars, it wastes. If the test is positive, God be with you. You have colon cancer and you are in deep doodoo. If the test is negative, what have you learned? Why… nothing! Doctors will say, Hey your Cologuard is negative, you’re good and send you home with a bellyful of polyps all growing into cancer. A negative Cologuard tests means absolutely nothing. In five years, Medicare coverage for it will be gone. And Medicare coverage or non-coverage for ANYTHING has never been a barometer of legitimacy, merit, applicability or need. It nixed PVP Greenlight lasers for BPH when they first came out only to realize the approach saves millions and is far safer than TURP.
Gastroenterologists everywhere, including me, are snickering at Cologuard and Exact Sciences.
I pose a challenge to ANYONE reading this who happens by: devise for me, if you will, a scenario in which Cologuard will be useful, save lives and be good for someone. Maybe I am blind, so point me in the right direction. Dream up a situation in which a smart doctor will direct a patient to use this, and it will HELP the patient, and be better than standard of care, and oh, while you’re at it, also NOT gratuitously cost the system money.
I’ll check back later, but I really want whoever posted the question in the lead-in part to answer my question. I am not out to humiliate you, but out to show you how INSANE Cologuard is.
is this test like hematest or hemacult?
No, it tests only for DNA unique to colon cancer. A certain set of genetic markers typifies 90 plus percent of colon cancer.
May I suggest this scenario as possibly adding some value for this product?
If a person has a great fear of surgery/colonoscopy and only wishes to do that as a last resort, can a negative result from this test be used a reasonably reliable basis for not having a colonoscopy or a second colonoscopy after 10 years?
I respect your point Howard. I would respond in these ways. One, I genuinely understand patient terror as few do. One reason I went into medicine is that I was born so neurotic that I routinely fainted when seeing blood or hearing a gory story up until when I began medical school. I wanted to overcome it, and even now, I am terrified of being a patient. I often share that with terrified patients because I want them to know I do not belittle them. I have sometimes shown them videos or had them speak with other terrified patients who lost their fear of colonoscopy after having one.
Second: What is the goal of colonoscopy? It is NOT to look for colon cancer. It is to look for polyps. ALL cancers begin, 5-15 years before they become cancer, as polyps. The goal of colonoscopy is to find all polyps and cleanly, painlessly use a thermal snare to remove them. If you wait til cancer is at hand, the barn has burned down. A negative Cologuard does not mean you do not have polyps and does not exclude cancer or pre-cancer, as absence of evidence is never evidence of absence. A negative Cologuard test in no way doesn’t mean one doesn’t need colonoscopy.
What’s going to happen is a Laurel and Hardy fine mess: people will skip colonoscopies, get cancer, get Cologuard, then get colonoscopy, then be diagnosed with cancer, then need surgery……and the whole system will be paying 10x what it does now! And after they have their colon removed and get a colostomy, they will still need annual colonoscopy for the next 10 years!
It is ALL prevented by screening colonoscopy beginning at 50 for most, at 45 for people of African ancestry, and for people with a first degree colon cancer relative, colonoscopy 10 years earlier than that relative’s age at diagnosis.
And on the effectiveness front, I think the argument for cologuard’s DNA component is really slim — compared to a much cheaper standard of three hemoccult tests it didn’t do significantly better as I remember. It did do slightly better than a single hemoccult, if my memory is correct (haven’t re-checked), but the cologuard also includes their version of the hemoccult test. This is one where logic really seems like it might win out, on costs if nothing else, and it is hard to see it making sense to do something so expensive that has limited (or maybe no) added value and might deter something that really does have added value (colonoscopy).
Hi DrK, I was listening to a local Dr. on the radio this weekend that likes the Cologuard because he had a patient that tested positive with Cologuard and was referred out for a follow up with a scope. The second Dr. didn’t find anything with the scope but, because of the test results, did more searching and found an area at/ in the appendix area that was malignant. The primary Dr. credits the test for saving his patients life.
Truthfully, I could be fuzzy on the details since the main reason I looked for a discussion on this topic here was to see if it might be something to invest in. After reading thru everything else I see that it likely is not going to be setting any records but just wanted to throw in what seemed like a good anecdote.
Claude
Please note that Dr KSS has left this building. He no longer reads or posts here. You responded to a note that is more than four years old.
If you are interested in bio tech investing, he started his own website called biopubkss.com. It requires a paid membership.
Agree Travis. The thing is, if one is afraid to undergo colonoscopy, is that person really prepared rationally to deal with a positive Cologuard test result,
Martin Mull is fond of saying: “Smoking? Hey ANYONE can quite smoking, but it TAKES A MAN to face lung cancer.” Same with Cologuard. When that test comes back positive, you are hosed: you have waited way too long! Get your colon run when you’re younger, before you can have cancer and get the polyps plucked before they ripen into something wayward, and Cologuard becomes useless. By the way, a negative Cologuard test in no way excuses you from needing colonoscopy. Colonoscopy is not to look for cancer. It’s to look for polyps, and remove those before cancer sets in. No other human cancer has the precise, predictable progression of hyperplastic polyp —->adenomatous polyp—–>malignant polyp—–>invasive colon cancer. This gives years to intervene.
I will be both shocked and disappointed if private payers ever cover it. I suspect Medicare will drop coverage soon. It is an irrational use of resources!
Again Thank You Dr. Kss. I needed to be put on the right path. I wrongly thought cologuard would detect polyps as they would be cancerous. I’ll schedule my colonoscopy now.
Alan: the likelihood of a polyp having cancer in it is proportionate to the polyp’s size. An old rule of thumb is that for a 1 cm polyp, there is a 40 per cent chance of it having a core nest of cancerous cells in it. I forget the exact slope of the curve of this relationship, but certainly by the time a polyp gets to be 4 cm, it is highly likely to be malignant (80 per cent or more).
Polyps commonly have a stalk. They are like mushrooms. The cancer starts in the head of the mushroom, and eventually can invade down the stalk and into the bowel wall. When we remove a polyp, we put a wire “lasso” on its base, against the bowel wall, and run some current through that to sever the stalk. We suck out the polyp through a scope channel (if it is huge, we use suction to get it to stick to the tip of the scope and then withdraw the scope). A pathologist breadloafs the polyp, and carefully inspects the stalk. If the stalk is cancer free, even if you had an aggressive cancer in the polyp you are in the clear.
Take home message: the polyp to cancer progression takes years. Polyps need to be removed. Cologuard is not positive unless there are malignant cells right on the very surface of the lesion in question. Which, as explained above, is seldom the case.
I agree with Dr KSS that this test reverses the current preventative process by testing for the existence of cancer rather than looking for polyps. So, not really sure how you justify this as being a viable product over the current process.
However, wonder if the test will be pushed by Exact Sciences to primary care doctors as part of a “preventative” yearly screening process in between the 5 / 10 year screening process for colonoscopies? What kind of kickback/fees do the doctors get as part of this test?
I’ve looked carefully at most of the above comments and have to respectfully disagree. This test is much like the PAP which has virtually eradicated cervical cancer in the screening population. The original PAP had similar sensitivities high 40’s% for CIN 2 and 3 as does CG in AA @ 2 cm because women get screened every 2 to 3 years through the magic of programmatic sensitivity the disease has been eradicated. 80 million americans and rising are in the CRC screening population less the 60% of these folks are current on any CRC screening. FIT performs miserably on Proximal AA’s. The Proximal SSA’s are believed to be the biggest culprit in the more aggressive neoplasia’s and a frequent site of interval CRC. If i was the CEO of CG, i would educate the medical community on the inconsistencies of Colonoscopy in the proximal; colon many many studies have established this. Whether it’s physiology, inadequate prep or the colonscopist just missed the difficult to see SSL’s? To say that a clean colonoscopy means no CRC for the next 10 years is fantasy. CG will programmatically pick up 70% of HGD and AA’s 3cm+ the most likely to turn malignant…. The larger the polyp theoretically the more DNA shed into the stool. I’m with CMS on this one – allow CG to screen the normal at risk population and let the pro’s perform the diagnostic colonoscopies. A positive CG will insure a better prep and a more attentive colonscopist imo. Pay the pro’s for these diagnostic colonscopies at a premium and lets eradicate this dreadful disease.
I’d throw you a rope and a flashlight, but I think you prefer being lost. Come back when you get board-certified in GI and we’ll talk. You’ve no clue how far off you are.
Your acronym soup is interesting but meaningless.
Next time you post, the etiquette is that you reveal any position in the stock in question. I suspect you’re blindly shilling.
Exact Sciences isn’t.
CG is stupid.
So, here’s what a good analysis of EXAS looks like:
http://www.marketwatch.com/story/a-very-exact-opportunity-in-biotech-2014-04-04
Exact Sciences Cologuard test will take over the FIT market (remember, it includes an FIT) about as fast as FIT took over FOBT.
At $500/test (price that will drift slowly upward as CMS adjusts to higher private rates) and about 4m tests per year domestic (doesn’t include international sales or pipeline development), EXAS earnings will be $6/share or higher by decade end. Expect a price somewhere north of $60 in 2-4 years and probably around $100 presuming no end of the financial world events.
I love it when non-gastroenterologists who’ve never touched a scope or cared for a patient try shamming their way through matters about which they know nothing. FIT never overtook FOBT. Cologuard is an utter waste of money and proof of how much stupidity abounds.
Randy, it comes to my attention that you’re clueless when you go around posting about colorectal cancer. You like to play devil’s advocate against Cologuard on this site, yet on another you say cologuard is a better option (than FIT). You also tout it as a “home test”.
You like to use big words like “serrated sessile lesions” an the like – what you don’t realize is what a small part of CRC actually metastasize due to SSL proximal (or distal for that mater) adenomas. You also say things like “cologard is a better option”…I respectfully disagree. By the way, so does the American College of Gastroenterology. And do you really think touting an Rx only, $500 test – that has a statistically imperceptible difference over fecal immunochemical testing – is a smart thing to do to a target audience which obviously has no insurance, or an absorbent deductible? “This Ford Focus is trash, you should get an Aston Martin.”
Tell you what – you can email me any time you like. I’d love the opportunity to set the record straight for you. Cbalentine@pblabs.com