Paging Dr. Frischer: Colorectal Cancer Screening
Colonoscopy is the traditional method used to screen for colorectal cancer. Note that exciting new alternatives to colonoscopy have been developed.
Screening for colorectal cancer is very important and is extremely effective. Sadly, the incidence of colon cancer keeps rising. Colon cancer is actually the most likely type of cancer to kill those under the age of 50, and colon cancer rates in adults under 50 have increased by a whopping 51% since 1994. Overall, colon cancer is the third most common cancer among men and women.
Most of those with colon cancer have no family history, but genetics does play a significant role. This makes family communication about cancer risk important; a reluctance to bring this up, or even to discuss it with one’s doctor, poses a huge hurdle to prevention. Diagnosing this cancer at late stages makes it far less treatable.
This is all very frustrating, because there are multiple effective screening tests, and colon cancer death is nearly completely preventable! It takes years for tumors to grow, and early tumors can be detected by colonoscopies, fecal tests like FIT or Cologuard, and now even blood tests like Cancerguard.
I urge you to speak with your doctor about screening. Currently, screening is recommended starting at the age of 45. Of course, if there are any warning signs, such as blood in the stool or a change in bowel habits, then any age is an appropriate time to screen. Screening is covered by health insurance at 45, and is covered at any age if there are indications.
The gold standard for colorectal screening is the colonoscopy. The entire colon is examined using a colonoscope, a flexible lighted tube. A tool is used to remove any abnormal growths, such as adenomas and polyps, which could be precancers. Preparation for the test requires thoroughly cleaning out the colon, and the procedure itself is performed under anesthesia.
The second most effective method is a stool test like Cologuard. This simply requires a stool sample to be collected at home and then easily mailed to a lab. Both polyps and colorectal cancers can bleed, and this test can detect very small amounts of blood in the stool, along with certain DNA biomarkers for cancers and polyps. (Blood in the stool can also indicate other conditions, such as hemorrhoids.)
Another testing option is virtual colonoscopy (also called computed tomographic colonography), which uses x-rays. The colon must be thoroughly cleaned beforehand (in a similar manner as for a colonoscopy).
The most recent development is a simple blood test. These blood tests might be offered to those who have not been willing or able to use other colorectal cancer screening methods.
If any of these alternative tests are positive, a colonoscopy would follow. Health insurance almost always covers colonoscopy, although there may be a co-pay. The Cologuard at-home stool test is almost always covered, and usually has no co-pay. The newer blood-based cancer screening tests have poor coverage at this point, as they are not yet FDA approved. I expect that their effectiveness and coverage will improve over time.
The most important thing is to get screened with any method. When caught early enough, colorectal cancers are relatively easy to treat.