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When Should You Start Colon Cancer Screenings?

A new recommendation for when to start colon and rectal cancer screening was recently issued by the American Cancer Society (ACS). Previously, the ACS’s recommendation was to start colon and rectum cancer (also called colorectal cancer) screenings at age 50. The ACS now recommends starting screenings at age 45. This important change, based on research, can help you and your family be more proactive about your health and catch colorectal cancer as early as possible.

Colorectal cancer is cancer that can involve the colon, the rectum, or both. It usually starts in a polyp, which is a small group of cells that can develop on the colon or rectum lining. Some polyps are not cancerous (and will never become cancerous), some can be precancerous and have a chance of turning into cancer, and some polyps develop into early-stage cancer.  

Why Is Colon Cancer Screening Important?

Screening is important because it can prevent colorectal cancer by finding anything abnormal and treating it promptly before it develops into cancer. When cancer is found early, it gives you a better chance to treat the cancer and save your life. 

Screening is also important because sometimes there are no early warning signs or symptoms of colorectal cancer. If you have symptoms, it could mean that cancer has already developed or even spread to other organs.

Remember that screening needs to be done regularly. Always follow your doctor’s recommendations about what tests you need and how often you need them. 

If you’re at least 45 years old with an average risk of colorectal cancer, it’s the right time to be proactive and ask your doctor about screening. The ACS also encourages you to start screening younger than age 45 if you have a high risk of this type of cancer. 

Do You Have an Average or High Risk of Developing Colorectal Cancer?

Your doctor or oncologist will recommend screening methods based on your individual needs and your own personal risk. Let’s look at the difference between average risk and high risk of developing colorectal cancer. 

  • Average risk means you are generally healthy and do not have a family history of colorectal cancer, as far as you know. With average risk, you should start screening at age 45 and continue to receive screenings until age 75. Your doctor will discuss whether it’s worth continuing with screenings after age 75.
  • High risk means you have certain contributing factors that could make you more likely to have colorectal cancer. These include a personal or family history of colon or rectal cancer, radiation of the pelvic region, or a history of inflammatory bowel disease. In this high-risk group, the recommendation is to start screenings before you reach age 45. You will also need more frequent screenings than the average-risk group. Your doctor will give you specific recommendations based on your overall health and age.

Why Did ACS Change the Screening Recommendation?

The ACS recommendation to lower the screening age was made after a full review of current research that shows a pattern of increasing rates of colorectal cancer among younger adults (people under the age of 50). The ACS lowered the screening age in order to detect colorectal cancer earlier and to potentially prevent some new cancer cases.

Cancer researchers are continuing to study why younger people are getting colorectal cancer. We already know that lifestyle choices can contribute to cancer. What you eat, how much you exercise, and your weight are key factors in your risk level. Smoking and heavy alcohol use also contribute to a high risk of cancer. 

Common Types of Colorectal Cancer Screening

There is more new information about colorectal cancer screening. The primary screening test for colorectal cancer used to be a colonoscopy. This requires a day of preparation before the procedure at a medical facility. But with recent advancements, an at-home stool sample test is often the first screening tests doctors will recommend. While everyone should have a colonoscopy periodically, the frequency can be less with these other tests available. This will hopefully encourage more people to start their colorectal cancer screenings on time.

Several types of both stool and visual screening tests for colorectal cancers are readily available.

Stool tests for colorectal cancer screening

These tests are prescribed by your doctor and are done at home. The results will be sent to your doctor’s office to review with you. They are typically covered by your healthcare insurance.

  • A fecal occult blood test (FOBT) looks for hidden blood in the stool. A small sample of stool is examined under a microscope. Blood may indicate polyps, cancer, or other conditions. It’s recommended that you have an FOBT once a year.
  • High sensitivity guaiac-based fecal occult blood test (HSgFOBT) is similar to the FOBT. It uses a different chemical to test the stool sample and determine if there is any blood in the stool. The ACS also recommends this test once per year.
  • An immunochemical fecal occult blood test uses a different chemical to check for antibodies that can show if there is blood in the stool. It is also called a fecal immunochemical test (FIT). 
  • DNA stool test checks the DNA in your stool for genetic changes that can indicate colorectal cancer. The ACS recommends it once every three years. 

Visual Colorectal Screening Tests

Visual tests require the patient to take laxatives to completely empty their colon. This may be in the form of a liquid to be consumed, or a pill that will help empty the colon as much as possible so the doctor is able to see inside the colon. 

Common colorectal cancer screening tests include: 

  • Sigmoidoscopy lets your doctor look inside your rectum and lower colon for polyps or other abnormal areas. A sigmoidoscope, a thin tube with a light and lens for viewing, is inserted through the rectum. Your doctor may recommend this be done every three to five years, depending on the results. It can be done every 5 to 10 years if you also have an annual FOBT or FIT test. A sigmoidoscopy cannot examine all six feet of your colon, just the lower part. 
  • Virtual colonoscopy is also called computed tomographic colonography (CTC). It uses specialized x-ray equipment to provide a series of images of the colon and the rectum from outside the body. It is recommended every five years.
  • Colonoscopy is considered another screening option. The patient is sedated, and a colonoscopy is used to look for polyps or abnormal areas in the rectum and entire length of your colon. The flexible, lighted tube has a lens for viewing and a tool for removing tissue or polyps. Any tissue removed is examined under a microscope. Colonoscopies are usually recommended every ten years if the first one was normal. Any of the above tests that detect an abnormal area will need to be followed up with a colonoscopy. 

One of the visual tests would be recommended if the doctor notices anything abnormal on a stool screening test. 

Your doctor will recommend the best method of screening for you based on your age, risk, and family history. Always talk with your doctor before ordering screening tests online for colorectal cancer or other conditions. The labs used by these other services may not be of the same quality, and the accuracy can vary widely.

Spread the Word About Colorectal Cancer Screening at Age 45

You can help reduce colorectal cancer by spreading the word about the importance of regular screenings. As Americans talk more about cancer prevention and become more comfortable with the topic, more people will understand the need to get screened and at younger ages.

Schedule your regular physical and talk to your doctor about which screening tests you need based on your age and risk factors. It can save your life.

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