Screening Options

Colon cancer and rectal cancer can be prevented. Through screening, a normal (benign) polyp called an adenoma can be removed before it becomes cancerous. Screening can also detect colorectal cancer early — when it is most curable.

All adults (men AND women) over the age of 50 are at risk for colorectal cancer and should be screened for adenomatous polyps and cancer. Some with higher risk should work with a doctor to develop an individualized screening plan.

See below for answers to commonly asked questions regarding colorectal cancer screening:

What are my screening options?

When & how should I be screened for colorectal cancer?

Where can I find a low-cost colonoscopy?

If my family has Lynch Syndrome or Familial Adenomatous Polyposis (FAP), how often should I be screened?


Screening Options

Screening-Methods-Chart.Aug2014

Flexible Sigmoidoscopy

A physician uses a sigmoidoscope to view the sigmoid colon and the rectum. Less than half of the large intestine and all of the rectum can be seen. An enema is done to clean out the lower part of the colon and the rectum; some doctors require that the entire colon must be cleaned out. Polyps can be removed with the sigmoidoscope.  Should be done in combination with gFOBT or FIT test.

Colonoscopy

A physician uses a colonoscope (longer than a sigmoidoscope) to view the entire colon and the rectum. The entire colon must be cleaned out in order to perform a colonoscopy.  Polyps can be removed with the colonoscope. This is often considered the “gold standard” for colon screening.

Double-Contrast Barium Enema (DCBE)

The DCBE is an x-ray of the colon and rectum that highlights abnormal areas.  The entire colon must be cleaned out.  The contrast solution is inserted through the anus and then drained.  Air is pumped into the colon, and x-rays are taken.  If abnormalities are found, the appropriate diagnostic procedure is performed.

CT colonography (virtual colonoscopy)

Colon screening through CT colonography is a non-invasive, advanced CT scan of the colon and rectum that produces 2 and 3-dimensional images of the colon and rectum that allows a doctor to look for polyps or cancer. The entire colon must be cleaned out. Air is pumped into the colon and the CT scan is taken.  If abnormalities are found, the appropriate diagnostic procedure is performed.  Polyps smaller than 5mm or less are not identified for removal.

Fecal occult blood test (gFOBT)

The gFOBT test is an in-home test used to detect blood that cannot be seen by the naked eye occurring in or on bowel movements. Stool is placed on a test strip, and sent to a facility that tests it for blood. Test results of either “positive” or “negative” determine if bleeding is occurring; however, it will not indicate the cause. To provide accurate samples, patients need to follow drug and dietary restrictions. The test is typically returned via mail pouch to the doctor or lab.  If a test result is positive, a diagnostic colonoscopy should be performed.

Fecal immunochemical test (FIT)

The FIT test works like the gFOBT test, however unlike the gFOBT, there are not drug and dietary restrictions.  The FIT is better at detecting blood than the gFOBT.

Stool DNA Tests

These tests look for abnormal sections of DNA in the stool rather than blood in the stool. A kit is provided, and the stool is mailed to a lab that looks for DNA.

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When & how should I be screened?

The American Cancer Society (ACS), and the US multi-society Task Force on Colorectal Cancer jointly recommend that patients of average risk and their doctors discuss options for colorectal cancer screening. ACS believes that preventing colorectal cancer (and not just finding it early) should be a major reason for getting tested. Finding and removing polyps keeps some people from getting colorectal cancer.

  • Tests that have the best chance of finding both polyps and cancer are preferred if these tests are available and you are willing to have them
  • Guidelines are for an average risk patient
  • Screening begins at age 50 for those of average risk
  • Applies to both men and women
  • Follow one of these testing schedules:

Tests that find both polyps and cancer:

    • Flexible sigmoidoscopy every 5 years*
    • Colonoscopy every 10 years
    • Double-contrast barium enema every 5 years*
    • CT colonography (virtual colonoscopy) every 5 years*,***

Tests that primarily find colon cancer:

    • Yearly fecal occult blood test (gFOBT)*,**
    • Yearly fecal immunochemical test (FIT)*,**

* If the test is positive, a colonoscopy should be performed.

** The multiple stool take-home test should be used. One test done by the doctor in the office is not adequate for testing. A colonoscopy should be performed if the test is positive.

*** May not be covered by insurance

For more information about the details of each screening method, read the American Cancer Society’s report on Colorectal Cancer Early Detection.


 What’s the Best Test for You?

cdc-chosing-right-test

The Centers for Disease Control and Prevention (CDC) released a Nov. 2013 Vital Signs report addressing screening rates and colorectal cancer tests that save lives.

Click the image to see the full infographic and find the best colorectal cancer screening test for you.

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Where can I find a FREE or low-cost colonoscopy?

Finding free or low-cost colon screenings can be challenging.  Many times these options are offered locally, within your own town or county.

Before you search, remember that there are several types of colon screening options; some which cost significantly less than colonoscopy. If you’re looking for low-cost or free colon screenings near you, we recommend contacting these resources:

The Center for Disease Control (CDC)

The CDC has a colorectal cancer screening program in some states. Click on the link to search for a CDC colorectal cancer screening program in your area.

Department of Health (DOH)

Your local Department of Health may have some colorectal cancer screening programs available.  Click on the link to locate your local Department of Health.

American Cancer Society (ACS)

ACS allows you to search by zipcode for screening programs. Click on their Search for Resources Page, enter your zip OR city/state information and select “Cancer Screening – Colorectal” from the Program Type drop down menu.

National Association of Community Health Centers

The National Association of Community Health Centers may be of some benefit to you. Learn more about the NACHC and their locations.

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What if my family has FAP or Lynch Syndrome?

If someone in your family has been diagnosed with a genetic syndrome that increases your risk for colon or rectal cancer, it is important to discuss the following screening options with your physician, as each individual is different.

The American Society of Clinical Oncology recommends these general screening guidelines for those with Lynch Syndrome:

  • Colonoscopy every one to two years, beginning between the ages of 20 to 25 (or five years younger than the earliest age at diagnosis in the family, whichever is sooner)
  • Periodic upper endoscopy screening (this procedure uses a thin, flexible tube with a light inserted into the body to examine a specific region) for stomach or intestinal cancer, especially if a family member has had one of these cancers
  • Yearly urine cytology to screen for urinary tract cancer

Screening for women

  • Yearly pelvic examination
  • Pap test
  • Transvaginal ultrasound (a test where a small ultrasound probe is inserted for a pelvic examination in order to obtain better imaging of the uterus)
  • Endometrial biopsy (an examination on a sample of tissue from the inner lining of the uterus done as a part of a pelvic examination)
  • CA-125 blood test (a test to detect a protein found to be elevated in the blood of some women with ovarian cancer) beginning between the ages of 25 to 30

Screening options may change over time as new technologies are developed and more is learned about Lynch Syndrome. It is important to talk with your doctor about appropriate screening tests.

Learn more about Lynch Syndrome.

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