The American Cancer Society (ACS) recommends that people at average risk* of colorectal cancer start regular screening at age 45. People at increased or high risk of colorectal cancer might need to start colorectal cancer screening before age 45. Screening for colorectal cancer can be achieved with a colonoscopy, an exam that visually looks at the colon and rectum, or with a sensitive test that looks for signs of cancer in a person’s stool. The different screening modalities all have pros and cons.
SCREENING OPTIONS:
Only option to DETECT AND PREVENT colorectal cancer:
- Colonoscopy – This is considered the gold standard of colorectal screening. Recommended for average and
higher risk patients.
- Pros: 95% accurate at detecting colorectal cancer. 1 step test, meaning polyp removal at time of exam; usually covered by insurance with no out-of-pocket.
- Cons: Prepping for exam, need to take a day off.
Non-preventative options to detect colorectal cancer. Colonoscopy required if test results are positive.
- FIT (Fecal Immunochemical Test) – First line test for average risk patients. 73.8% accurate at detecting colorectal cancer.
- Pros: Easy to do, no change to diet or medication regimen.
- Cons: Does not detect all cancers or polyps, has to be completed every year.
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Cologuard – Second line test for average risk patients.
- Pros: Can be completed at home.
- Cons: $500 out of pocket expense not covered by all insurances. Up to 45% false positive. Not recommended by American College of Physicians. Has to be completed every 3 years. If positive, colonoscopy needs to be completed.
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Blood Based – Endorsed by ACS for those unwilling/unable to do colonoscopy or stool-based testing.
- Pros: Easy to do, no change to diet or medication regimen.
- Cons: Does not detect all cancers or polyps, has to be completed every 3 years.
Am I high risk of having colorectal cancer? If you answer yes to the following, you are at a higher risk of having colorectal cancer and should have the gold standard colonoscopy.
- Personal history of colorectal cancer or certain types of colon polyps
- Family history of colorectal cancer? Start at Age 40 or 10 years before age of diagnosis
- Personal history of Inflammatory Bowel Disease (Ulcerative Colitis or Crohn’s disease)
- Symptoms such as persistent change in bowel habits or stool consistency, abdominal discomfort, rectal bleeding or blood in stool, unexplained weight loss, anemia, fatigue or weakness.
- A confirmed or suspected hereditary colorectal cancer syndrome, such as familial adenomatous polyposis (FAP) or Lynch syndrome (hereditary non-polyposis colorectal cancer or HNPCC)
- A personal history of getting radiation to the abdomen (belly) or pelvic area to treat a prior cancer