Understanding Colon Cancer Screening: When and How Should You Get Screened?

Colon cancer ranks as the second-deadliest cancer in the United States, following lung cancer. However, recent updates on colon cancer screening guidelines may have left many individuals feeling unsure about when and how to proceed. Here’s what you need to know to make informed decisions about colon cancer screening.

Different Perspectives on Screening
The guidance on colon cancer screening varies among major organizations, including the American College of Physicians (ACP), the American Cancer Society (ACS), and the US Preventive Services Task Force (USPSTF). The primary point of divergence lies in the recommended age to commence screening. The ACP suggests starting at age 50, whereas the ACS and USPSTF advocate for initiating screening at age 45.

The rationale for Earlier Screening
The rationale for earlier screening stems from a concerning trend: a notable increase in colon cancer incidence among individuals under 50. This rise in cases among younger adults has led to a corresponding increase in deaths from colon cancer within this age group. Moreover, the incidence of early-onset colon cancer varies across racial and ethnic groups, with disparities observed among Alaskan Natives, Native Americans, Blacks, and African Americans.

Available Screening Tests
Two primary screening methods are widely employed for colon cancer detection: colonoscopy and stool-based tests.

Colonoscopy: This gold-standard procedure involves a gastroenterologist inserting a flexible tube equipped with a camera into the colon to examine its entire length. Colonoscopy can detect and remove precancerous polyps (adenomas), offering a comprehensive screening approach.

• Individuals with no polyps identified typically undergo repeat colonoscopy after 10 years.
• Serious complications are rare but can include perforation or bleeding.

Stool-based Tests:
Stool tests, such as fecal occult blood test (FOBT) and fecal immunochemical test (FIT), are non-invasive options that detect blood in stool samples, which may indicate the presence of adenomas.

• FOBT and FIT should be performed annually.
• Another option, the FIT-DNA test, combines blood and DNA analysis and is typically repeated every three years.

Considerations for Younger Adults
Colonoscopy may not be the optimal initial screening test for everyone, particularly younger individuals who may find it inconvenient or time-consuming. Stool-based tests offer a suitable alternative, requiring minimal time and effort. Dr. Chan emphasizes that taking proactive steps, such as opting for stool-based screening when necessary, is crucial for early detection and prevention.

Navigating colon cancer screening recommendations can be challenging, but it’s essential to prioritize early detection, especially given the rising incidence of colon cancer among younger adults. Consultation with a healthcare provider can help determine the most appropriate screening strategy based on individual risk factors and preferences. Remember, early intervention can significantly impact outcomes and reduce the burden of colon cancer.