With the information available to us today, it is often hard to determine when you should be screened for colon cancer or not. In a recent study led by the American Cancer Society (ACS) the age to start colorectal screening was lowered. The study concluded that there is an increase in colorectal cancer rates in younger adults and the incidence in the United States is increasing. Given these results the ACS now recommends that colorectal cancer screening begin at age 45 years for adults with average risk factors.
To understand the new guidelines and what has changed, let’s dig deeper into:
- Screening age recommendations,
- Types of colorectal screening tests,
- How to determine if you are at “average” or “above average” risk,
- What should you do next after reading this article?
Screening Age Recommendations
If you are at average risk for getting colon cancer (see also section below on how to determine if you are at average risk or not), you should:
- Start at Age 45: People at average risk of colorectal cancer should get their first screening at age 45.
- Continue to Get Regular Screening: As long as you remain in good health and have a life expectancy of more than 10 years, you should continue to get regular colorectal cancer screening tests through age 75.
- If You Are 76 – 85 Years of Age: If you are age 76 through 85, you should talk with your doctor about whether you be screened or not, your personal preferences for the type of test or screening you would receive, your life expectancy based on your health status and your cancer screening history to date.
Types of Colorectal Screening Tests
No matter which type of screening test you choose, it is important to get screened! You can discuss the pros and cons of each type of screening test with your doctor, but here are some general differences to keep in mind:
Stool-Based Tests
- FIT: this is a highly sensitive stool sample test that looks for immunochemical results. This test should be taken once each year
- gFOBT: this is another highly sensitive test that looks for hidden blood in the stool and should be taken once each year. Your doctor may refer to this as a guiac-based focal occult blood test.
- MT-sDNA: this test uses a stool sample to look at multiple results in the DNA. It should be taken once every three (3) years.
Visual Tests
- Colonoscopy: this exam can be given as an outpatient and requires only minimal sedation. It does require preparation for the study using 24-48 hours prior to the test. It should be given once every ten (10) years.
- CT Colonography (or virtual colonoscopy): also requires preparation before the test can be given and can be performed as an outpatient with minimal sedation. CT Colonography should be performed once every five (5) years.
- Flexible Sigmoidoscopy (FSIG): FSIG also requires 24-48 hours of preparation before testing and sedation. If chosen it should be given once every five (5) years.
Regardless of the type of testing you choose, regular testing is important. You can talk with your doctor about the intervals for testing to ensure you are being appropriately screened.
How to Determine if You Are at “Average” or “Above Average” Risk
You should know your personal and family history when you talk about colorectal cancer screening with your doctor. Individuals at “higher risk” may need to select a different schedule or type of testing. You may be at higher risk for developing a colorectal cancer in your lifetime if you have a:
- Strong family history of colorectal cancer or certain types of polyps. Family history typically refers to your parents, grandparents, siblings, aunts or uncles,
- Personal history of colorectal cancer or certain types of polyps,
- Personal history of inflammatory bowel disease, ulcerative colitis or Crohn’s disease,
- Known family history of a hereditary colorectal cancer syndrome such as familial adenomatous polyposis (FAP) or Lynch Syndrome. Lynch Syndrome may also be referred to as hereditary non-polyposis colon cancer or HNPCC.
- Personal history of radiation to the abdomen, belly or pelvic area to treat a prior cancer.
What Should You Do Next?
After reviewing the changes in the guidelines discussed above and getting familiar with the types of colorectal screening tests available, you should make an appointment to visit your doctor and talk about what screening is best for you. Remember, it is important to test, no matter what and early detection may save your life!
Where to Get More Information
To read more about the ACS study, you can get the entire guideline in an article published May 30, 2018 in CA: A Cancer Journal for Clinicians, an American Cancer Society journal.
