Colorectal Cancer Screenings: What Are My Options?

Colonoscopy is not the only way to screen for colorectal cancer. Here are your options.

Colorectal cancer is the third most common cancer in the U.S., excluding skin cancers, and is the second leading cause of cancer death. It affects men and women nearly equally. Overall, the lifetime risk for developing colorectal cancer is about 1 in 22 for men and 1 in 24 for women.

The disease typically produces no symptoms until it’s in more advanced stages, but screenings can detect colorectal cancer at earlier stages, when it’s most treatable. That’s why it’s so important to get screened. But far too few people do.

One reason for this is due to the fact that some people avoid colonoscopies because they’re afraid of the procedure – and they think this is the only screening option available. But although colonoscopies are the best way to detect colorectal cancer, they are not the only screening option. There are other less invasive screenings available to those who are at low to average risk for the disease.

Below is an overview of your options for colorectal cancer screening. No matter which option you choose, the most important thing is that you get screened regularly.

Colorectal Cancer Screening Options

Stool-Based Tests:

• Cologuard® – This is the only stool DNA test approved by the FDA for colorectal cancer screening. A stool sample is collected by the patient using a kit and is mailed to a laboratory for testing. A computer program analyzes the sample and is able to identify nine DNA biomarkers in three genes that may be found in colorectal cancer and pre-cancerous adenomas. It can also detect tiny amounts of blood in the stool. If results are positive, you will be advised to get a colonoscopy.
• Fecal Occult Blood Test (FOBT) / Fecal Immunochemical Test (FIT) – Colorectal cancer and pre-cancerous polyps can bleed and this test is sensitive enough to detect the presence of blood even if it’s not visible to the eye. These non-invasive tests uses stool samples collected by the patient to check for tiny amounts of blood in the stool. The at-home kits can be obtained from a doctor’s office, ordered online or bought over the counter. It is recommended that the test be done yearly. If an abnormal result occurs, it should be followed up with a colonoscopy. The tests can give false positive results due to other conditions, such as hemorrhoids.

Visual Tests:

• Colonoscopy – This is the most traditional and comprehensive screening test for colorectal cancer. To prepare for the test, you will have to do a bowel prep and you’ll be sedated during the exam. The doctor will use a flexible lighted tube with a small camera on the end to look at the entire length of your colon and rectum. If polyps are found, they can often be removed during the test and will then be biopsied. You’ll be instructed to repeat the test in 5 years or sooner. If nothing is found, you will not have to repeat the test for 10 years.
• Flexible Sigmoidoscopy – This test is similar to a colonoscopy but doesn’t look at the entire length of the colon. It requires a bowel prep that is not as extensive as the one required before a colonoscopy and you are typically not sedated during the test. If anything suspicious is seen, it will be recommended that you have a colonoscopy so the doctor can look at the entire span of your colon.
• CT Colonography – Also referred to as a virtual colonoscopy, you’ll still have to do a bowel prep but will not be sedated during the test. Air will be pumped into the rectum and colon and then a CT scan will take images so the doctor can look for polyps or cancer. If something is seen that may need to be biopsied, it will be recommended that you get a colonoscopy.

You should talk to your healthcare provider about when to begin screenings for colorectal cancer. Many physicians recommend screenings begin at age 50 and continue until age 75. The American Cancer Society now recommends screenings beginning at age 45 due to the rise in colorectal cancer rates in younger adults.

These screening guidelines are for people at average risk for the disease. If you have a personal history of colorectal cancer, pre-cancerous polyps or inflammatory bowel disease (including ulcerative colitis or Crohn’s disease), or you have a family history of colorectal cancer or other known risk factors, you may need to begin screenings at an earlier age.

The best way to reduce your colorectal cancer risk is to get regular screenings. Talk with your primary care doctor or gastroenterologist about which screening option is right for you.