Colorectal Cancer Screening
Colon cancer and rectal cancer can be prevented with screening. Screening can also detect colorectal cancer early – when it’s most curable.
The type of colorectal cancer screening you need will depend on your risk. If you have a higher risk of developing colorectal cancer, you should work with your doctor to create an individualized screening plan.
If you’re experiencing any signs of colorectal cancer, this may also influence your screening options.
All adults over age 45 are at risk for colorectal cancer and should talk to their doctor about screening for adenomatous polyps and cancer. Anyone seeing signs of colorectal cancer also needs to get checked. Most testing options are approved by the USPSTF and covered by insurers.
Colonoscopy is often considered the “gold standard” for colon screening because it can identify polyps and remove them during the same procedure.
What is a Colonoscopy?
A colonoscopy is a procedure where a colonoscope (a thin, flexible tube) is inserted into the colon and guided all the way through to the cecum (where the colon begins and the small bowel ends). To get to the colon, the colonoscope is inserted through the rectum.
The colonoscope has a digital camera and light attached to the end that allows doctors to see any abnormalities. This is why a colonoscopy is often referred to as a direct visualization test.
During the procedure, the doctor will carefully examine the colon and rectum by looking for any growths or abnormalities. If any polyps are identified, the doctor can biopsy and remove them.
To perform a colonoscopy, the entire colon must be cleaned out. This process is called colonoscopy prep, or simply “prep,” and involves taking a laxative and following dietary restrictions. Most often, patients are required to adhere to a clear liquid diet the day before the procedure. Read colonoscopy prep tips.
The cost of a colonoscopy will depend on your insurance plan and coverage. If you’re considering skipping or postponing screening because you don’t have insurance or the funding, think again. There are ways to get a free or low-cost colonoscopy.
- CDC’s CRCCP program: If you’re over age 50, check the Center for Disease Control and Prevention’s Colorectal Cancer Control Program (CRCCP) to see if you’re eligible for free screening from a grantee near you.
- Colonoscopy Assist: A colon cancer screening program designed to remove financial barriers to colorectal cancer screening for the uninsured.
- Local Health Departments: Call your local health department and ask if there’s a state-funded program near you.
- Primary Care Referrals: Ask your PCP if they know of a gastroenterologist who provides services to underinsured or uninsured. During March, Colorectal Cancer Awareness Month, many health care providers offer reduced-cost or free colonoscopies.
Stool tests are typically done at home. Each comes with a set of instructions that are important to follow because each test is unique. For stool tests to work, you MUST do them regularly (annually or every three years, depending on the test). You will not have to touch the stool (but do a thorough hand washing once you’ve collected the sample).
Get a stool test for colorectal cancer from your health care provider. According to the NCCRT, stool-based tests are covered by the vast majority of insurers, including Medicare and many Medicaid plans. Both FIT and mt-sDNA tests must be ordered by a clinician, most commonly the patient’s primary care clinicians, although the tests can be ordered through urgent care centers, retail clinics, or independent telehealth providers.
Learn more about the NCCRT’s efforts to maintain screening progress during the COVID-19 pandemic.
A stool DNA test (like Cologuard ®) is an at-home test that looks for abnormal sections of DNA within the stool in addition to blood. You will be given instructions about how to use it the stool DNA kit at home, and where to send it when completed. One stool sample is needed.
The gFOBT test is an in-home test used to detect blood in or on your bowel movements that can’t be seen by the naked eye. When you get a test, you will be given instructions about how to use it, which medications and foods to avoid (such as non-steroidal anti-inflammatory drugs and others), and where to send the completed test. Three stool samples are needed.
Test results of either “positive” or “negative” determine if bleeding is occurring; however, they don’t indicate the cause. If your test result is positive, talk to your doctor about getting a diagnostic colonoscopy to figure out the cause of the bleeding.
Fit Test (Fecal Immunochemical Test)
The FIT test works like the gFOBT test, however unlike the gFOBT, there are no drug or dietary restrictions. This test is also better at detecting blood than the gFOBT. One stool sample is needed.
Virtual colonoscopy, also called CT colonography, is a non-invasive, advanced CT scan of the colon and rectum that produces two and three-dimensional images of the colon and rectum, allowing the doctor to look for polyps or cancer within the images.
The entire colon must be cleaned out for this procedure. If abnormalities are found, your doctor will talk to you about the appropriate diagnostic procedure moving forward.
Prior to a flex sig, an enema is done to clean out the lower part of the colon and the rectum. A doctor then uses a sigmoidoscope to look at the sigmoid colon and the rectum, removing any visible polyps. Because less than half of the large intestine and all of the rectum can be seen with this method, they are often done in combination with the gFOBT or FIT test, to test for blood in the stool.
High Risk for Colorectal Cancer Screening
If you or someone in your family has been diagnosed with a genetic syndrome (like Lynch syndrome) that increases the risk for colon or rectal cancer, it’s important to discuss colorectal cancer screening options with your doctor, as you may need to start screening earlier and get screened more frequently than the average-risk population.
It’s important to remember that rectal and colon cancer screening options may change over time as new technologies are developed and we learn more about genetic syndromes like Lynch and FAP. It’s important to talk with your doctor about appropriate screening tests and come up with the screening plan that works best for you.
To read about the screening recommendations for high-risk people with a genetic predisposition to colorectal cancer, download the Genetics Mini Magazine.
Removing Barriers to Screening
As an advocacy organization, we are relentlessly fighting to remove any and all barriers to colorectal cancer screenings. Learn more about our policy efforts that are pushing lawmakers to remove barriers to colorectal cancer screening.
Colorectal Cancer Screening Resources
Visit our Resource Library’s Screening Resources to learn more, which includes a downloadable rack card, Screening Mini Magazine and PSAs about screening.
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