Among cancers that affect both men and women, colorectal cancer (cancer of the colon or rectum) is the second leading cause of cancer deaths in the United States. Every year, about 140,000 Americans are diagnosed with colorectal cancer, and more than 50,000 people die from it. The good news is more than 90% of colon cancer deaths can be prevented with timely removal of pre-cancerous polyps. In fact, it is one of the few types of cancer that can actually be prevented, which makes it all the more important to consider your risk for the disease and take steps to be tested at the appropriate time.
Signs and Symptoms
Precancerous polyps and colorectal cancer don’t always cause symptoms, especially at first. You could have polyps or colorectal cancer and not know it; that is why having a screening test is so important. If you have symptoms, they may include:
- Blood in or on the stool
- Stomach pain, aches, or cramps that do not go away
- Losing weight and you don’t know why
When to Begin Screening
The American Cancer Society, the U.S. Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology jointly recommended screening for colorectal cancer beginning at 50 years of age. Colonoscopy is considered the preferred method. Patients at increased risk for colorectal cancer including those with a single first degree relative (immediate family member) with colorectal cancer , particularly if diagnosed under age 60, patients with Crohn’s disease or ulcerative colitits or African American patients should be screened earlier than age 50. Talk with your healthcare provider or gastroenterologist about when is the appropriate age for you to begin screening. For more specific screening guidelines you can visit http://gi.org/guideline/colorectal-cancer-screening/
Once you have been screened, your physician will make recommendations on the timing of your next screening depending on the findings.
The decision to be screened after age 80 should be made on an individual basis after discussing it with your primary care provider and GI specialist.
What African-Americans Should know about Colorectal Cancer Screening
Although all men and women are at risk for colorectal cancer, some people are at higher risk for the disease because of age, lifestyle or personal and family medical history. According to studies, African-Americans are at higher risk for the disease than other populations. Research shows that African-Americans are being diagnosed at a younger average age than other people. Therefore, it is suggested that African Americans should begin their screening at age 45.
Recommended Screening Test and Intervals
- High-sensitivity fecal occult blood test (FOBT): which checks for hidden blood in three consecutive stool samples, this should be done every year.
- Flexible sigmoidoscopy: where physicians use a flexible, lighted tube (sigmoidoscope) to look at the interior walls of the rectum and part of the colon. Should be done every five years.
- Double contrast barium enema: is a series of x-ray images of the entire colon and rectum taken after the patient is given an enema with a barium solution. It is rarely used for screening because it is less sensitive than colonoscopy for detecting small polyps and cancers. However, it may be used for people who cannot undergo standard colonoscopy.
- CT colonography (“virtual colonoscopy”): is a test that uses a CT scanner to take images of the entire bowel. These images are in two and three dimensions, and are reconstructed to allow a radiologist to determine if polyps or cancers are present. If an abnormal area is found, a colonoscopy will still be needed at a later time to see the area and take a tissue sample. This test may not be covered by health insurance plans.
Colonoscopy: A colonoscopy is done under sedation where the physician inserts a long, flexible, narrow tube with a light and tiny camera on one end into the rectum and through the large intestine to examine the lining. During this procedure, samples of tissue may be collected for closer examination, or polyps may be removed. Colonoscopies can be used as screening tests or as follow-up diagnostic tools when the results of another screening test are positive. This should be done every 10 years and depending on exam findings. Colonoscopy is considered the gold standard of colorectal cancer screening methods for its ability to view the entire colon and both detect and remove polyps during the same procedure.