What is colorectal cancer screening, and when should you start?
Colorectal cancer screening is a way to check for early signs of cancer or precancerous growths in the colon or rectum. Most adults should start at age 45, even if they feel healthy and have no symptoms.
This guide explains what colorectal cancer screening is, why it matters, your options for screening, and what to expect if you need to have a colonoscopy.
What Is Colorectal Cancer Screening?
Screening for colorectal cancer is a test that looks for changes in your colon or rectum that are pre-cancerous or cancerous before you develop any symptoms. During the screening, the doctor may:
- Identify the presence of polyps, which are small growths that can become cancerous.
- Detect the presence of cancer early, when there is still time for treatments to help.
- Prevent cancer by removing polyps before they become dangerous.
The Two Main Types of Screening Tests Include:
- Tests that evaluate your stool to check for the presence of hidden blood or changes in the DNA.
- A visual exam called a colonoscopy involves a doctor looking directly inside your colon with a colonoscope.
Why Colorectal Cancer Screening Is So Important
Colorectal cancer often develops slowly and gradually and often does not cause any symptoms at first. Many people feel completely normal in the early stages, but catching it quickly allows time for effective treatment.
Screening Matters Because It Can:
- Catch cancer before any symptoms start
- Identify and remove any precancerous polyps
- Help begin cancer treatment at an earlier stage, when it may be more effective.
The American Cancer Society reports that when colorectal cancer is found early, the 5-year survival rate is around 90 percent. This rate drops significantly if it is detected during later stages.
What Are the Colorectal Cancer Screening Guidelines?
The recommendations for screening are based on your age and how high your risk level is.
For Most Adults (Average Risk)
- Screening should begin at age 45.
- Regular routine screenings continue through age 75, which is normally every 10 years.
- Between the ages of 76 and 85, screening will depend on your health and past results.
For Adults Who Are At Higher Risk
You may need to start screening earlier or have more frequent screenings if you have:
- A family or personal history of polyps or colorectal cancer.
- Inflammatory bowel disease (IBD), such as Crohn’s disease or ulcerative colitis.
- Genetic conditions like Lynch syndrome or familial adenomatous polyposis (FAP).
- Undergone previous radiation therapy on your abdomen or pelvis.
Choosing the Right Screening Test
There is no single test that works for everyone, and the one that works best for you will depend on your health, preferences, and risk factors.
Colonoscopy
A colonoscopy is an endoscopic procedure where your doctor uses a special medical device with a camera to look at your entire colon. This allows your doctor to get a clear view of anything that looks abnormal.
One of the biggest benefits of having a colonoscopy is that your doctor can often remove polyps during the same visit. This means the test can both find and prevent cancer at the same time. The downside is that a colonoscopy does require bowel prep the day before and sedation during the procedure.
Experts recommend that most people have a colonoscopy every 10 years unless they are at higher risk.
Stool-Based Tests
Stool-based tests are done in the privacy of your own home and are much easier because there is no need for sedation or an in-office procedure. You collect a small sample at home using a special kit, which is sent to a lab, where it will be tested.
These tests check for hidden blood or certain genetic markers in your stool. These tests usually need to be done every one to three years. The most common test options include:
- FIT (fecal immunochemical test) is normally done once a year.
- Stool DNA tests can be done every 1 to 3 years.
If a stool test comes back positive, it does not mean you have cancer. It means you will need to have a colonoscopy to determine the underlying cause of your results.
Which Screening Test Is Right For You?
The test that is best for you will depend on your health, risk level, and what your preferences are.
Some people would rather have a colonoscopy because it is done less often and allows for immediate treatment if needed. Others like stool tests because they can be done at home, do not require unpleasant preparation, and there is no need to take a day off from work.
Deciding on which test to choose may depend on:
- Your comfort in undergoing a medical procedure
- Willingness to complete the necessary bowel prep
- Your access to care, specialists, or insurance coverage
- The recommendations of your doctor.
What to Expect During a Colonoscopy
A colonoscopy is one of the most common tests used to identify cancerous or pre-cancerous cells in the colon.
There is some preparation that must be done beforehand, and you should plan on taking the day of your procedure off from work.
Most patients will need to follow a specific diet plan two to three days before the colonoscopy to clear the colon so the doctor can get an unobstructed view of the area.
Before Your Procedure
- You will follow a clear liquid diet.
- You will drink a bowel prep solution to clean out your colon (you will spend the next several hours taking trips to the bathroom).
During the Procedure
- You will be given sedation medication to help you relax.
- A thin, flexible tube with a camera (endoscope) is inserted into your colon.
- The doctor checks for polyps or areas that appear abnormal.
If Polyps Are Found
- They are often removed right away.
- Some tissue is normally sent for testing.
After the Procedure
- You go home the same day and may be groggy for several hours from the sedation, so you should not drive.
- You may experience mild bloating or gas, which is common.
- Most people can return to their normal schedule the next day.
When to Talk to Your Doctor About Screening
You should talk to your doctor about colorectal cancer screening if any of the following apply to you:
- You are at least 45 years old and have never been screened.
- You have any of the following symptoms:
- Blood in stool
- Ongoing changes in bowel habits
- Unexplained weight loss
- You have a family history of colorectal cancer or polyps.
- You have had polyps removed in the past.
Do not wait until you begin to experience symptoms, and schedule your screening to catch any problems early.
Where Can I Learn More About Colorectal Cancer Screening?
Dr. Okeefe Simmons is a triple board-certified physician at Simmons MD Weight & Healthcare Solutions and offers colorectal cancer screening in Miami, FL.
He specializes in endoscopic procedures and has performed thousands throughout his career. He has also published multiple research papers and contributed chapters to many textbooks in this field.
Dr. Simmons also helps teach and train gastroenterology fellowship students at the Miami Veterans Affairs (VA) Medical Center.
Set up your colonoscopy consultation today.
FAQs
Is Colorectal Cancer Screening Covered by Insurance?
Yes. Most insurance plans cover screening starting at age 45 for average-risk adults. Check with your specific insurance carrier to determine if your plan provides coverage and the types of tests included.
Does a Positive Stool Test Mean I Have Cancer?
No. It means something abnormal was found, and you will need to have a colonoscopy to find the cause, which could be polyps or other non-cancerous conditions.
Is a Colonoscopy Painful?
You will be under sedation, so you should not feel any pain and most likely will not even remember the procedure.
What if I Am Worried About the Prep Before My Colonoscopy?
The bowel prep process has improved over the past several years, and doctors often use split doses or lower-volume options that may be easier for you to tolerate.
Can I Stop Screening at A Certain Age?
The current recommendation is that screening continues until you reach age 75. After that, it depends on your health and past results, so you should rely on guidance from your doctor.
