Colorectal Cancer Screening: A Must-Read for Everyone Over 45

In the realm of health, we often encounter stories that serve as stark reminders of the importance of preventive measures. Among these tales, one that hits close to home is that of a colleague of mine—an individual who, by all accounts, was the epitome of health and wellness. This colleague, known for running marathons and exhibiting exceptional discipline both in the workplace and in personal fitness, was the last person anyone would expect to face a health crisis.

Yet, despite his remarkable physical condition, he overlooked the subtle, yet crucial, signals that his body was sending him. Blood in his stool, initially sporadic, went unheeded. Months passed, and it was only when fatigue set in that he took action, supplementing his diet to combat what he believed was overtraining. Fast forward two years, after completing a triathlon, he was suddenly struck by abdominal pain. An abdominal CT scan revealed the unthinkable—a colonic mass necessitating surgery, cancer treatment, and the use of a colostomy bag.

Regrettably, this story is not unique. Many individuals find themselves in a similar situation, their fate potentially altered had they acted differently and paid heed to the early warning signs from their bodies.

Colorectal Cancer: The Silent Threat

Colorectal cancer stands as the third most frequently diagnosed cancer in both men and women in the United States. Yet, it also holds the distinction of being one of the most preventable cancers through early detection and intervention.

This leads us to a pivotal discussion: colorectal cancer screening. It is an essential step in safeguarding your health and ensuring that this disease doesn’t go unnoticed until it’s too late.

When Should Screening Begin?

According to the American Cancer Society, adults at average risk should commence colorectal cancer screening at the age of 45. However, those at higher risk may need to initiate screening earlier or do so more frequently.

Exploring Screening Options

Colorectal cancer screening comes in two main categories: stool-based tests and visual exams.

Stool-based tests are non-invasive and can be conducted in the comfort of your own home. These tests examine stool samples for suggestive signs of cancer.

Visual exams, on the other hand, require a doctor’s expertise to inspect the colon and rectum directly for potential cancerous abnormalities.

Selecting the Right Test for You

Your healthcare provider plays a crucial role in helping you choose the screening test that aligns with your health history, age, and family background.

Screening Frequency

The frequency of screening depends on the type of test you opt for:

Stool-based Tests

  • The guaiac-based fecal occult blood test (gFOBT) uses the chemical guaiac to detect blood in the stool. It is done once a year. For this test, you receive a test kit from your healthcare provider. At home, you use a stick or brush to obtain a small amount of stool. You return the test kit to the doctor or a lab, where the stool samples are checked for the presence of blood.
  • The fecal immunochemical test (FIT) uses antibodies to detect blood in the stool. It is also done once a year in the same way as a gFOBT.
  • The FIT-DNA test (also referred to as the stool DNA test) combines the FIT with a test that detects altered DNA in the stool. For this test, you collect an entire bowel movement and send it to a lab, where it is checked for altered DNA and for the presence of blood. It is done once every three years.

From the Division of Cancer Prevention and Control, Centers for Disease Control and Prevention. Colorectal Cancer Screening Tests. February 23, 2023. https://www.cdc.gov

Visual Exams

  • Colonoscopy: comprehensive exam performed by a physician utilizing a small, flexible tube inserted into the rectum and spanning the entire colon. Recommended every 10 years.
  • Flexible sigmoidoscopy: brief exam performed by a physician similar to a colonoscopy to visualize the lower third of the colon. Suggested every 5-10 years.
  • Virtual colonoscopy (CT Colonography): CT Scan that non-invasively reconstructs x-ray imaging to virtually provide a very detailed colonic evaluation. Typically performed every 5 years.

Positive Screening Results

If your initial screening test produces a positive result, don’t be alarmed. Your doctor will likely recommend a follow-up test, such as a colonoscopy, to gain a more thorough understanding of the findings.

Identifying Those at Increased Risk

Certain individuals are at a higher risk of developing colorectal cancer. These may include those with a family history of the disease, inflammatory bowel disease, specific genetic syndromes, a history of smoking, prior polyps or colorectal cancer, and those who are overweight or obese. These individuals may require earlier or more frequent screening.

Initiate the Conversation with Your Doctor

Colorectal cancer screening should be a pivotal part of your health regimen. Engage in a discussion with your healthcare provider to assess your risk factors and determine which screening test aligns with your needs and medical history.

Tips for Streamlining the Screening Process

Finally, here are a few tips to make the colorectal cancer screening process more manageable:

  • Consult Your Doctor: Seek guidance from your healthcare provider, who can demystify the various screening tests and recommend the one best suited to your circumstances.
  • Choose a Convenient Time: Schedule your screening test at a time that aligns with your convenience. 
  • Don’t Hesitate to Seek Help: If you require assistance scheduling your screening or need guidance on preparation, don’t hesitate to reach out to your doctor or nurse.

In conclusion, colorectal cancer screening is a critical aspect of maintaining your health and well-being. It has the potential to save lives, making it a vital step in your journey toward a healthier, cancer-free future.