Which colorectal screening is right for you?

As you approach age 45 — or earlier if you have a family history of colon cancer or other risk factors — you may wonder which colorectal cancer screening test is right for you. And you may ask friends about their colonoscopy experiences or pay closer attention to commercials about home testing kits.

However, according to Dr. Susan Chu, chief of gastroenterology for Sharp Rees-Stealy Medical Group, your best bet would be to have a conversation with your primary care provider about your options.

“Colorectal screening may seem like a complex issue, but it’s one your doctor can help you with,” Dr. Chu says. “Screening decisions are made on a case-by-case basis, and your doctor can help you make the choice that is right for you with the national guidelines in mind.”

Understanding the national guidelines on screening
According to the guidelines created by the U.S. Multi-Society Task Force of Colorectal Cancer (MSTF) — a group comprised of national experts in primary care, surgery, radiology, oncology and gastroenterology — adults age 45 to 75 should be screened for colorectal cancer — also known as bowel, colon or rectal cancer — whether or not they have any signs or symptoms.

Recent research has shown that the rate of cancer among adults under age 50 has risen 1 to 3% each year for the past two decades. Therefore, people who have certain risk factors may need to begin colorectal cancer screening prior to turning 45. This includes those with family members who developed colorectal cancer or polyps before age 60 or who have a personal history of colorectal cancer, polyps or chronic inflammatory bowel disease. In particular, African Americans have one of the higher risks of colorectal cancer and are recommended to start screening at age 45.

Diet and lifestyle factors — including smoking, a sedentary lifestyle and obesity — can also affect your risk of developing precancerous polyps and colon cancer. Along with minimizing or eliminating your lifestyle risk factors and paying attention to significant changes in your bowel habits or persistent rectal bleeding, screening — and early treatment, if cancer is diagnosed — reduces the risk of dying from the illness.

Types of colorectal cancer screening tests
There are a few different types of colorectal cancer screening tests recognized by the MSTF, which recommends the first two as its top choices:

• Colonoscopy: During this outpatient procedure, your doctor uses a scope — a tiny camera attached to a long, thin tube — to look for signs of cancer, including inflamed tissue, abnormal growths and ulcers, in your entire colon and rectum.
   

• Fecal immunochemical test (FIT): This screening tests for hidden, microscopic blood from the lower intestines in the stool, which can be an early sign of cancer or precancerous polyps. Stool samples collected at home are sent to a lab for testing.
   

• Sigmoidoscopy: Like the colonoscopy, your doctor uses a scope during this outpatient procedure to look for signs of cancer. However, only the rectum and lower colon are screened.
   

• Cologuard®: This brand-name, multi-targeted stool DNA colorectal cancer test detects the presence of abnormal cells or blood in the stool that may indicate cancer or precancerous tumors. Collection of your stool is completed at home and sent to a lab.
   

• Computed tomography (CT) colonography: Also known as virtual colonoscopy, a radiologist inserts a small tube into the rectum to allow for inflation with gas and uses X-ray equipment to examine the large intestine for cancer and polyps. This test is mainly for those who cannot undergo a colonoscopy or have had an unsuccessful colonoscopy.

Which screening test should you choose?
“Cologuard does a great job at promoting colorectal cancer awareness through advertisements and might be right for some people in some circumstances,” says Dr. Chu. “Colonoscopy is the most technically accurate single test but requires a bit more planning and preparation. The FIT test is simplest to perform and the most cost-effective on an annual basis. It is also considered the most cost-effective on a population level.”

A colonoscopy every 10 years or FIT tests every year are recommended as the foundation for screening. Sharp Rees-Stealy is piloting a recommendation by the MSTF of encouraging lower-risk patients to start with FIT and higher-risk patients to start with colonoscopy.

“Eventually we hope every at-risk patient will get a colonoscopy,” Dr. Chu says. “The American Cancer Society has recommended lowering the screening age to 45, but there are some concerns by some experts that this might shift currently available screening resources from higher-risk individuals who haven’t been screened to lower-risk patients. This is an issue that is currently being debated in the gastroenterology community.”

While CT colonography every five years, multi-targeted stool DNA every three years and flexible sigmoidoscopy every five to 10 years are appropriate screening tests, colonoscopy remains the most accurate colorectal cancer test. Furthermore, if polyps, signs of cancer or other abnormalities are discovered during any of the other tests, a follow-up colonoscopy will be necessary for further investigation.

Avoid barriers to screening for best health
It is estimated that 1 in 21 men and 1 in 23 women will develop colon cancer during their lifetime. Unfortunately, only one-third of adults in the U.S. have been screened, even though screening has been proven to save lives.

According to Dr. Chu, there are a variety of barriers to screening, from socioeconomic reasons to access, lack of transportation and language barriers. Others may have concerns about procedure preparation and risks.

However, the benefits of screening far outweigh the risks in those under age 85, when complications from colonoscopy — bleeding, infection, a hole in the intestine or complications related to sedation — may increase. And screening preparation, which includes bowel cleansing, can be customized to decrease discomfort.

Talk to your doctor about your colorectal cancer screening choices. “The best screening test is the one that gets done,” Dr. Chu says.