Colorectal Cancer Screening: What You Need To Know
Let’s face it. Reading about colorectal screening isn’t high on anyone’s “favorite things” list. But because of your favorite things—like your spouse, kids, pets, business, and hobbies—this is a very important article to read.
Start Younger. Live Longer.
Colorectal cancer (which includes colon and rectal cancer) rates among younger Americans are increasing and are on track for a 90% increase in people between the ages of 20 and 34 by 2030. That same study estimates the rate for men and women between the ages of 35 and 49 will increase by 28%. The fact that younger patients tend to have more aggressive colorectal cancers is also a cause for concern.
But it isn’t all doom and gloom. Although colorectal cancer accounts for the second highest number of cancer deaths, when caught early enough it can often be successfully treated. Because polyps found in the colon can take 10 to 15 years to develop into cancer, removing these growths can reduce or eliminate the colon cancer risk for the patient.
More good news! When your gastroenterologist performs your screening colonoscopy, any observed polyps can be removed at the same time, reducing the likelihood of needing a separate procedure.
If you have any symptoms—including rectal bleeding or blood in your stool, change in bowel habits lasting longer than four weeks or unusual, persistent abdominal pains or discomfort—you should see your doctor and follow their instructions for testing and follow-up.
Who Is Considered Average Risk?
In 2018, the American Cancer Society announced revised recommendations for colorectal screening for individuals at average risk. This includes those who don’t have a personal history of colorectal issues, a strong family history of colorectal cancer or other factors that would indicate a need for early screening. Guidelines are as follows:
- Those at average risk should begin regular screening at age 45. “Regular” is an important part of the equation, so be sure to follow your doctor’s recommendations for follow-up screening or treatment.
- People who are in good health and have a life expectancy of more than 10 years should continue regular colorectal screening through age 75.
- Individuals who are 76 through 85 should discuss the need for screening with their medical provider based on current health, preferences and results of previous screening exams.
- People who are older than 85 should no longer undergo colorectal screening.
Who Has An Increased Risk?
So how do you know if you fall into the higher-than-average risk category and need earlier or more frequent screenings? Here are a few factors doctors and researchers look at:
- Strong family history of colorectal cancer or certain types of polyps.
- Personal history of colorectal cancer or certain types of polyps.
- Current or previous inflammatory bowel disease like Crohn’s disease or ulcerative colitis.
- Radiation to abdomen or pelvic area to treat a previous cancer.
- Family history of hereditary colorectal cancer syndrome including familial adenomatous polyposis (FAP) or Lynch syndrome (also called hereditary non-polyposis colon cancer or HNPCC).
- Other medical issues as determined by your physician.
If it’s determined that your risk is higher than average, you and your doctor should decide upon the most appropriate type of screening, as well as the frequency.
When it comes to medical testing, there’s the ideal world—in which everyone does the recommended screening at the right intervals—but the reality is that achieving 100% screening compliance is unlikely. Talk with your doctor about the best option and frequency for your health and history. Here is an overview of screening types:
- Colonoscopy — Every 10 Years | Considered to be the gold standard of colorectal screening, this test combines a visual exam of the colon with the ability to remove polyps during the procedure. You will be lightly sedated while the physician inspects your colon with a thin flexible tube that has a camera on the end.
- CT Colonography (Virtual Colonoscopy) — Every 5 Years | This screening is carried out using a CT scan. Although it is non-invasive (versus a regular colonoscopy), you still need to complete bowel prep prior to the exam. If any polyps or other issues are identified, you will most likely need to undergo a normal colonoscopy.
- Flexible Sigmoidoscopy — Every 5 Years | Similar to a colonoscopy, this screening also uses a flexible tube with a camera. However, this test only looks at the lower part of the colon (the rectum and sigmoid colon) rather than the entire colon. If any concerns are uncovered, you may require a full colonoscopy.
- Fecal Occult Blood Test — Every Year | In addition to the above visual exams, there are several types of stool-based tests that look for occult (hidden) blood, including fecal immunochemical test (FIT) and guaiac-based fecal occult blood test (gFOBT). Able to be done at home or in your doctor’s office, fecal matter is spread on a card and sent to a lab for analysis.
- Multi-targeted Stool DNA Test (MT-sDNA) — Every 3 years | This fecal analysis looks for occult blood and damaged DNA. You may have seen advertisements for this type of screening marketed as Cologuard™. This is also completed by sending your stool sample to a lab using the provided kit which must be ordered by your physician. Depending on the results, you may need a follow-up colonoscopy.
This article is designed to provide a general overview of the colorectal screening recommendations issued by the American Cancer Society in 2018. It is not intended to serve as specific medical advice. Every patient is different and should contact their own doctor to determine the most appropriate screening approach.