The Stitch

Which colorectal cancer screening is right for me?

Colorectal cancer is a type of cancer that affects the colon and rectum, which are part of the large intestine. It is the third most common cancer in the world and the second leading cause of cancer-related deaths in the United States. It is estimated that nearly 53,000 people will die from colorectal cancer this year. However, it is highly treatable and can often be prevented through early detection.

Instrument for endoscopy in the doctor's hands.“We know that screening is effective,” says Dr. Yesenia Rojas-Khalil, a colorectal surgeon at Baylor College of Medicine. “Since 2005 when we started emphasizing the importance of screening for colon and rectal cancer, we saw a decline in the number of cases in the age group recommended for screenings.”

Because there are often no symptoms of colorectal cancer during its early stage, regular screening is essential for early detection and can significantly increase the chances of successful treatment. A few years ago, the American Cancer Society and U.S. Preventative Task Force updated their guidelines from screening at age 45 from age 50. There are several different screening methods available, including colonoscopies and Cologuard tests.

Colonoscopy vs. Cologuard

Colonoscopies are procedures done with sedation and involve the insertion of a flexible tube with a camera on the end through the anus, allowing doctors to visually examine the lining of the colon and rectum for any polyps, which are small clumps of cells that can develop into cancer if not removed. Colonoscopies are considered the gold standard for colorectal cancer screening and are recommended every 10 years starting at age 45 or earlier for those with a family history of colorectal cancer.

Cologuard is a non-invasive, stool-based screening test that detects abnormal DNA (like that found in cancer) and blood in the stool, which can be a sign of colorectal cancer. If a Cologuard test comes back abnormal, then a colonoscopy is recommended. Stool-based screening tests, like Cologuard, are typically repeated every 1-3 years for those at average risk of colorectal cancer.

“In general, I recommend colonoscopies for screening,” says Rojas-Khalil. “The benefit of a colonoscopy over a stool-based test is you can find and remove small polyps before they become cancerous.”

Rojas-Khalil says if patients have comorbid conditions or difficulties with anesthesia, then the Cologuard test is the best option. But for most patients, a colonoscopy is recommended.

Those that are at high risk for colon or rectal cancers include those who have Crohn’s disease, Ulcerative colitis, a genetic mutation predisposing you to colorectal cancer or personal history of polyps.

Colorectal cancer affecting younger patients

Unfortunately, colorectal cancer is no longer a disease of the elderly. Although the recommended age for screening is 45, Rojas-Khalil says she has seen patients in their 30s and younger with colorectal cancer. Although the exact reasons are unknown, Rojas-Khalil says avoiding excess processed foods, which have been linked to colon cancer, and advocating for your health are important.

“Be an advocate for yourself,” she says. “You know your body better than anyone else. If you have new symptoms such as anemia, bloating, inability to eat much or blood in your stool, and you don’t feel the symptoms are being adequately addressed, you should seek another opinion.”

Colorectal cancer is a common and potentially deadly disease but it can be prevented and treated with regular screening and prompt medical attention. It is important to speak with your healthcare provider about your risk for colorectal cancer and the best screening options for you. Remember early detection is key to successful treatment and recovery.

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