Colon Screening: What You Need to Know

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Colorectal Cancer is the third deadliest cancer in the United States, despite being one of the most preventable. Once thought to almost exclusively affect people over fifty, colorectal cancer in younger populations is on the rise. In 2023, it is estimated that 1 in 8 patients diagnosed with colorectal cancer will be between 20 and 49 years of age.

The high number of deaths associated with colorectal cancer can be attributed to underuse of screening available to patients. Screening, which is directly linked to colorectal cancer deaths in the United States, is more common nowadays, but many Americans are not up to date with their screenings or have neglected to have one at all.

In this article we’ll talk about why screening matters and what you should know before talking to your doctor about protecting yourself from colorectal cancer.

What is screening?

There are a handful of screening options out there, from stool sample testing to CT colonoscopies, also called virtual colonoscopies. These basic screening techniques are helpful for giving your doctor an impression of your overall colon health, but there is one gold standard for detecting, treating, and preventing colorectal cancer: colonoscopies.

The difference between colonoscopies and other screening techniques are significant. Minimally-invasive screenings, like a flexible sigmoidoscopy—a procedure similar to a colonoscopy—only evaluate the lower part of your colon, and therefore cannot detect cancer or precancerous tissue throughout your large intestine. Non-invasive screenings, like at-home or in-clinic stool sample testing, can detect cancer—but they cannot detect abnormalities that lead to cancer, and therefore cannot prevent cancer before it forms.

Colonoscopies not only ensure that the entire colon is investigated for cancer or precancerous lesions, but during a colonoscopy, abnormalities are removed, preventing cancer from developing altogether.

What are abnormalities?

Abnormalities in the colon are called polyps. Polyps are fleshy lumps in the lining of the bowel caused by the abnormal production of cells. If they aren’t removed, polyps can evolve into cancer. If polyps are removed, then colorectal cancer can be prevented altogether. Colonoscopies are the only means of detecting and removing polyps.

It is unclear exactly how or why polyps form, but there are several factors that increase the risk of developing polyps. Some of the most common include:

• Family history of polyps or colorectal cancer
• Age - 40% of people 50 and over have precancerous polyps
• Smoking and alcohol use
• Obesity - a BMI of 25 or higher puts people at greater risk
• Race - Black Americans are at a higher risk of developing cancer
• Certain hereditary disorders, including polyposis syndrome

Not all polyps are precancerous, but a doctor must remove and test them to make that determination. During a colonoscopy, all polyps are automatically removed. If you have polyps, depending on their risk for mutating into cancer, your doctor might recommend more frequent screenings and other lifestyle changes you can make to protect your colon health.

Should I get screened?

Starting at age 45, everyone regardless of race or gender should get their first colon screening, but you should get one earlier if you are considered higher risk. High-risk individuals are people with a family history of colorectal cancer or polyps or people experiencing symptoms. If you have a family history, your doctor will often recommend earlier screening. If a parent had colorectal cancer, for example, your doctor may recommend you get your first screening ten years before the age that your family member was diagnosed.

With or without a family history of elevated risk, you should still be on the lookout for symptoms:

• Rectal bleeding - The most concerning sign of colorectal cancer is rectal bleeding, or blood in the stool. Many people ignore it or explain it away as hemorrhoids, but if you experience rectal bleeding, or if your stool looks red or black in color, see your doctor immediately.
• Change in bowel habits - Any persistent change in your bowel habits should not be ignored. How often you go, how much you go, what your stool looks like, whether you’ve developed consistent constipation or diarrhea—all of these should be brought up with your doctor.
• Iron deficiency anemia - Even if blood doesn’t show up in your stool, polyps can bleed slowly over time, depleting your body of the iron necessary for red blood cells to function. If you feel tired, weak, dizzy, or short of breath, talk to your doctor.
• Pain - A belly ache that won’t go away might be more than a stomach bug. Large polyps or tumors can block part of your bowel, leading to persistent abdominal pain.

Pay attention to your body, and don’t ignore symptoms if they arise. However, colorectal cancer more often has no symptoms at all. Even if you are not experiencing symptoms, stay on top of your regular screening. Screening can detect cancer that has no outward signs.

So how do I get screened?

Talk to your doctor. Your primary care physician will be able to assess your risk and offer you the best options for you. They will work with you to ensure you get access to the testing and treatment you need. Screenings may be covered by your health insurance policy or Medicare. Fort HealthCare’s Community Care Program is available to patients who require additional financial assistance for covering healthcare costs.

Don’t wait. If you’re 45 and at average risk, or if you have a family history or are experiencing symptoms, schedule your colonoscopy with your doctor right away. If you’ve already had your first screening, check with your doctor that you are up to date. Screenings are recommended every 5-10 years, depending on your risk level and other key factors.

Stop cancer before it starts. Talk to your doctor about scheduling your colonoscopy today.

Sources: American Cancer Society, American Society for Gastrointestinal Endoscopy, CDC, Mayo Clinic, National Cancer Institute