Colorectal Cancer Screening

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Routine colorectal cancer screening is the best way to prevent colon cancer or find it at any early, more treatable stage. Both men and women should adopt a regular screening schedule, beginning at age 45.

“The American Cancer Society lowered the recommended starting age for colonoscopies from 50 to 45,” says Raquel Wagman, MD, a radiation oncologist at CBMC. “The incidence of colorectal cancer is increasing dramatically in younger patients. And we have a variety of new ways to treat and even cure it— when we catch it early.” After age 45, people should be screened every 10 years.

Some people need screening at an earlier age or more often. Ask your doctor about your screening schedule if you:

• Have a personal or family history of colorectal cancer
• Have had polyps (growths in the intestines that can turn into cancer)
• Have a history of inflammatory bowel disease, such as Crohn’s or ulcerative colitis
• Have had radiation therapy to the belly or pelvis
• Have a family history of other conditions, like Lynch syndrome or familial adenomatous polyposis (FAP)

Colorectal Cancer Screening Tests

Several tests can be used to screen for colorectal cancers. These tests can be divided into:

• Tests that can find both colorectal polyps and cancer. These tests look at the structure of the colon itself to identify any abnormal areas. They are done either with a scope put into the rectum or with special imaging tests. Polyps found during these procedures can be removed, so these tests may prevent colorectal cancer. These tests are preferred if they are available and you are willing to have them.

• Tests that detect cancer. These tests check stool for signs of cancer. While they are less invasive and easier to have done, they are less likely to detect polyps.

Tests That Can Find Both Colorectal Polyps and Cancer

• Flexible sigmoidoscopy. A thin, flexible, lighted tube with a small video camera on the end is put into the rectum to view the rectum and the lower part of the colon. If an abnormality is seen, it can be biopsied or removed. Less than half of the colon can be seen with this procedure.
• Colonoscopy. Similar to a flexible sigmoidoscopy, a colonoscopy allows the entire length of the colon and rectum to be viewed. If any abnormalities are seen, they can be biopsied or removed.
• Double-contrast barium enema. In this x-ray test, air and a chalky liquid called barium sulfate are put into the colon and rectum to outline the inner lining. If suspicious areas are identified, a colonoscopy will be recommended to explore them.
• CT colonography. Also known as virtual colonoscopy, this test is an advanced type of computerized tomography (CT) scan of the colon and rectum. Special computer programs create both 2D and 3D views of the inside of the colon and rectum. This test may be useful for people who can’t—or don’t want to—have more invasive tests.

Tests That Mainly Find Cancer

• Fecal occult blood test (FOBT). This test detects hidden blood in the stool through a chemical reaction, but cannot tell if the blood is from the colon or from other parts of the digestive tract.
• Fecal immunochemical test (FIT). Similar to an FOBT, this test detects hidden blood in the stool, but through a different chemical reaction.
• Cologuard® colon cancer test. This test detects hidden blood in the stool, as well as abnormal cell associated with colon cancer and precancerous polyps.