Have you been putting off your colorectal cancer screening? Did you know that when colorectal cancer is detected in its early stages before it has spread, the 5-year relative survival rate is about 90%. However, only about 4 out of 10 colorectal cancers are found at this early stage.
The death rate (the number of deaths per 100,000 people per year) from colorectal cancer has been falling for several decades. According to Raaj K. Popli, M.D., a board-certified gastroenterologist at Digestive Disease Consultants, a primary reason why is that colorectal polyps are now being discovered more often by regular screening and removed before they can develop into cancers or are being found earlier when the disease is easier to treat.
“Colorectal cancer is one of the most common cancers unfortunately in this country,” says Dr. Popli. “Currently, it’s the second leading cause of cancer deaths, but there is good news. Colon cancer is one that we feel like we can largely prevent in this day and age. It’s very important that patients come in and get an evaluation along those lines and see if there’s a way that we can prevent colon cancer.”
Who Is at Risk for Colorectal Cancer?
Colorectal cancer is the fourth most common cancer diagnosed in both men and women in the U.S. Your risk of getting colorectal cancer increases as you age. Over 90% of those diagnosed with the disease are aged 50 years or older. Other risk factors include:
- Inflammatory bowel diseases such as Crohn’s disease or ulcerative colitis
- A family history of colorectal cancer or colorectal polyps
- A genetic syndrome such as familial adenomatous polyposis (FAP) or hereditary non-polyposis colorectal cancer (Lynch syndrome)
- A sedentary lifestyle with minimal exercise
- A diet low in fruit and vegetables
- Being overweight or obese
- Alcohol consumption
- Tobacco use
It is important to note that the ACS recommendation to start screening at age 45 is a qualified recommendation, meaning there are definite benefits of screening at the younger age, but there is less certainty about the balance and harms, or concerning patients’ values and preferences, which could lead to different decisions about screening.
This is opposed to a strong recommendation, where the benefit is clear and almost everyone should do it (starting screening at age 50 still remains a strong recommendation from the ACS).
Other guideline-producing organizations such as the US Preventive Services Task Force (USPSTF) have not changed their recommendations for colorectal screening, which still remain at age 50 to start.
Moreover, there is as yet no evidence that insurance companies are going to cover the testing for the younger age group. Younger patients may have to pay out-of-pocket if they decide to follow the new ACS guidelines. You should check with your insurance company about their 2019 coverage decisions for screening.
Types of Colorectal Cancer Screening
The Centers for Disease Control and Prevention (CDC) recommends that adults aged 50 to 75 be screened for colorectal cancer. People at an increased risk of developing colorectal cancer should talk to their doctors about when to begin screening, which test is right for them, and how often to get tested.
Several screening tests can be used to find polyps or colorectal cancer. You should consult your gastroenterologist to determine which of the following tests are right for you.
- The guaiac-based fecal occult blood test (gFOBT) is an annual at-home exam to detect blood in the stool.
- The fecal immunochemical test (FIT) is administered in the same way as a gFOBT but uses antibodies to uncover blood in the stool.
- The stool DNA test is done once every one to three years to identify altered DNA in the stool. You collect an entire bowel movement and send it to a lab to be examined for cancer cells.
Your physician will insert a small, flexible, lighted tube into your rectum and check for polyps or cancer inside your rectum and the lower portion of your intestine. The test should be conducted every 5-10 years.
A colonoscopy is a procedural examination of the inner walls of the rectum and colon (the large intestine). The test is performed through a flexible tube (about the width of a finger) called a colonoscope. A colonoscopy allows a gastroenterologist to establish the presence of polyps, cancer, diverticulitis, colitis, and other colonic conditions.
A colonoscopy can also be employed as a follow-up test if anything unusual is found during one of the other screening tests. Regular colonoscopy screening is recommended every ten years.
“Many people are aware of the colonoscopy,” says Dr. Popli. “The current guidelines state that all Americans over the age of 50 should get screened for colorectal cancer, and we feel like we can prevent colon cancer in many instances with that. Here at Palm Endoscopy Center, we perform colonoscopies in a safe, friendly, and pain-free environment. Most of our patients report great satisfaction with the procedure. There’s a lot of fear regarding a colonoscopy, but we happily answer all of those fears and most people come out with a great experience.”
How Do I Know Which Screening Test Is Right for Me?
Every type of screening test has its pros and cons, and there is no exact perfect fit for everyone. Your GI doctor will be able to guide you, and together you’ll decide which is the best option for you and how often to be tested.
Your choice of screening test will depend on:
- Personal preferences
- Medical history
- The probability of having the test
- The available resources for testing and follow-up
If you’d like to learn more about colonoscopy or how colorectal cancer screening can help you prevent the onset or progression of the disease, please feel free to contact us. We’ll be happy to answer any of your questions and address any of your concerns.