Colon Cancer Screening: Time for an Update

If you are under the age of 50 you might not realize that you are due for colon cancer screening but based on guidelines recently published you could be!

Starting in 2018 the American Cancer Society made a recommendation for earlier screening and then in May of 2021 the United States Preventative Task Force provided formal guidelines that colon cancer screening begin at age 45 rather than at age 50 as was previously recommended. 

This guideline applies to all people with average risk for colon cancer. 

If you are at higher risk screening may need to start sooner.  High risk individuals include people with certain genetic conditions such as familial adenomatous polyposis or hereditary non-polyposis colorectal cancer, inflammatory bowel disease or if you or a close relative have had colorectal cancer. 

There are 6 different testing options for colon cancer screening.

Three tests are stool based and three tests are visual exams of the colon. 

The stool-based tests are collected at home and turned in through the mail or to the lab. 

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They include:

Highly sensitive fecal immunochemical test (FIT) is done yearly and looks for blood in the stool with the use of antibodies.

Highly sensitive guaiac-based fecal occult blood test (FOBT) is also done yearly and uses a chemical called guaiac to look for any evidence of blood in the stool.

Multi-targeted stool DNA test (Cologuard) is done every 3 years and uses the FIT technology and also looks for any alterations in DNA.

If any of the above stool tests return abnormal your doctor will recommend a colonoscopy as the next step.

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Colonoscopy is performed with a thin flexible lighted scope under camera guidance so that the doctor can visualize and evaluate the colon for polyps or cancer and is done every 10 years.

Flexible sigmoidoscopy is similar to a colonoscopy but is limited to the lower third of the colon and is done every 5 years.

Computed tomography (CT) colonography is a scan using x-ray technology to create images of the colon for a Radiologist to interpret and look for any signs of abnormality, this is done every 5 years.

The three studies above visualize the colon and the screening intervals can change depending on the findings.

Screening continues until age 75 years as long as life expectancy is more than 10 years, between age 76-85 the decision to continue to screen is determined by discussion between patient and doctor and screening is not recommended after age 85 years old.

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All six tests are considered valid to screen for colon cancer. Speak to your doctor to determine which one might be right for you!

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