Colon Cancer Screening

Colon cancer is the third most common cancer in both men and women in the U.S. However, colon cancer is one of the few cancers that can be detected in its pre-cancerous stage.

In 2021, the U.S. Preventive Services Task Force changed its recommendation to encourage people at average risk for colon cancer to consider screening starting at age 45.

The incidence of colon cancer is increasing in younger age groups. People under 55 accounted for 11% of colon cancer cases in 1995. By 2019, the rate had nearly doubled to 20%.

Who should be be screened?

Your health care provider can help you decide how and when to begin screening. Check with your insurance carrier to understand what screening tests are covered. Here are the general guidelines:

For people at average risk for developing colon cancer, the U.S. Preventive Services Task Force recommends screening starting at age 45.
Those with a family history of colon cancer, particularly a first degree relative - parent or sibling - may need to begin earlier.
Some forms of inflammatory bowel disease - such as Crohn’s or ulcerative colitis - increase the risk of colon cancer and can warrant an early start to screening.
Screening should continue until age 75 or if life expectancy is less than 10 years.

What are the screening options?

Colonoscopy

Colonosocpy is considered the gold standard for colon cancer screening because it allows for both detection and removal of pre-cancerous polyps.

A colonoscopy is a procedure that allows a gastroenterologist to use a scope with a camera to look inside the colon. During this procedure, biopsies can be taken and polyps removed.
The day before your test, you will need to drink a bowel prep that cleanses out the colon to allow for optimal visualization of the colon.
You may also have to hold medications such as blood thinners or insulin, but this will be discussed with your doctor prior to the test.
Sedation is necessary, so you will need someone to drive you home after the procedure.
As with any procedure, there is a small risk of complication. This includes infection, bleeding and tears in the bowel. However, this risk if quite small and does not outweigh the risks associated with undiagnosed colon cancer.

The results of the screening colonoscopy determine the recommendations for future screenings.

If you are at average risk for colon cancer, then colonoscopy screening is every 10 years.
If adenomatous or serrated polyps are found, colonoscopy is recommended sooner because of a higher risk of malignancy.
If symptoms develop between screening intervals, you may need to have colonoscopy done sooner.

FIT (fecal immunochemical test)

The FIT - or fecal immunochemical test - can be done at home and detects blood in the stool.

FIT should be performed every year starting at age 45.
FIT cannot detect polyps and does not allow for direct visualization of the colon, or biopsies, which can miss some cancers.
No sedation, bowel prep, dietary modifications or medication restrictions are indicated.
There is a risk of false-positive results with FIT.
If the test returns positive, then colonoscopy screening is indicated.

Stool DNA testing

Stool DNA testing, which includes tests like Cologuard, can be done at home and looks for altered DNA in the stool.

Stool DNA test should be repeated every three years.
No bowel prep, sedation, or dietary or medication restrictions are required.
Stool DNA tests do not allow for direct visualization of the colon, polyps removal or biopsy.
It does have a risk of false-positive results.
If a DNA stool test is positive, colonoscopy is indicated.