Your Complete Guide To Colon Cancer Screening

Scientists are continually developing colon screening to check for specific forms of cancer before the appearance of any symptoms or signs. The general goals of a colon cancer test are to decrease the number of people who develop or die from the disease.

Here you'll learn more about the guidelines on screening for colon cancer, including who should be screened, how it's done, and if insurance covers it.

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Colon cancer screening guidelines

Various organizations have come up with their own guidelines on colorectal cancer screening. However, there's a general consensus that screening should take place on all average-risk adults between 50 and 75 years old¹.

Routine colon cancer screening within this age group is recommended by²:

  • American Cancer Society (ACS)

  • American Academy of Family Physicians (AAFP)

  • US Multi-Society Task Force (includes the American Gastroenterological Association, American College of Gastroenterology, and the American Society for Gastrointestinal Endoscopy)

  • American College of Physicians (ACP)

The frequency of screening and specific recommended tests might vary among organizations.

Who should be screened for colon cancer, and how often?

Again, there are different recommendations, depending on the organization. For instance, the ACS recommends that individuals at average risk of colon cancer³ begin routine screening at 45.

Screening should be done either with a stool-based test (a sensitive test where the doctor checks your stool for signs of cancer) or with a visual exam (the doctor examines your rectum and colon using a scope).

Those with a life expectancy of over ten years and in good health should continue to receive routine colon cancer screening through to the age of 75.

Those who are 76-85 years old will be screened depending on their life expectancy, prior screening history, overall health, and personal preferences. Individuals over 85 no longer require colorectal cancer screening.

What's considered "average risk" for colon cancer?

For screening, you're considered at average risk⁴ if you don't have:

  • A family history of colon cancer

  • A personal history of colon cancer or specific forms of polyps

  • A suspected or confirmed hereditary colon cancer syndromes like Lynch syndrome (HNPCC or hereditary nonpolyposis colon cancer) or familial adenomatous polyposis (FAP)

  • A personal history of IBS or inflammatory bowel disease (Crohn's disease or ulcerative colitis)

  • A personal history of pelvic area or abdominal (belly) radiation to treat a previous cancer

What's considered "high-risk" for colon cancer

Individuals at high risk of colon cancer⁵ may require screening before they turn 45, might require specific tests, or might require more frequent screening. This includes individuals with:

  • A personal history or strong family history of colon cancer or specific forms of polyps

  • A personal history of IBS (Crohn's disease or ulcerative colitis)

  • A known hereditary colon cancer syndrome family history like FAP or Lynch syndrome

  • A personal history of abdominal or pelvic area radiation to treat a previous cancer

Types of colorectal cancer screening

Since colorectal cancer typically doesn't cause symptoms until the cancer is advanced, it's important that you talk with your doctor about the advantages and disadvantages of each screening and how frequently each should be provided.

Your doctor may use one of the following colon cancer tests to screen you:

1. Colonoscopy

This is the most common way to screen for colon cancer. A colonoscopy enables your physician to look inside your entire colon and rectum while you're sedated. They'll insert a flexible, lighted tube (colonoscope) into your colon and rectum to check the entire area for cancer or polyps.

During the test, your doctor can remove tissue or polyps for a lab to examine (biopsy). Removing the polyps can also help prevent colon cancer.

2. Sigmoidoscopy

This procedure uses a tool with a flexible, lighted tube that the doctor inserts into your lower colon and rectum to look for cancer polyps and other abnormalities. Your doctor will remove tissue or polyps during this procedure for a lab to examine later. With this method, they can't check the upper part of your colon (the transverse and ascending colon).

This procedure allows the doctor to remove any polyps, helping to prevent colon cancer. If cancer is found or suspected, the doctor will probably schedule a colonoscopy to check the whole colon.

3. Computed tomography (CAT or CT) colonography

CT colonography (also called virtual colonoscopy) is a screening technique some centers are currently studying. It requires a skilled radiologist's interpretation to provide optimal results. Radiologists are doctors who specialize in getting and interpreting medical imaging.

People who can't have a regular colonoscopy because of either a colon blockage preventing a complete examination or because of the anesthesia risk may benefit from a CT colonography.

4. Stool DNA tests

This screening analyzes the DNA from a sample of your stool to check for cancer. It uses DNA changes that occur in cancer and polyps to determine if the doctor should perform a colonoscopy.

5. Fecal occult blood test

“Occult” means “hidden.” Doctors will use this test to identify unseen blood in your stool, which could be a sign of cancer or polyps. If they find blood (positive test), it can be due to causes other than colon cancer or polyp, including upper GI tract or stomach bleeding and even consuming rare meats or other types of foods.

There are two types of testing for occult blood:

  • Immunochemical (FIT)

  • Guaiac (FOBT)

Cancers and polyps don't bleed continuously, so FOBT needs to be done on a few stool samples each year, and you need to repeat it every year.

6. Double-contrast barium enema (DCBE)

If you can't have a colonoscopy, your doctor can give you an enema that contains barium. This is an element that helps your rectum and colon to show up better on X-rays. They'll then take a series of x-rays of your rectum and colon.

Generally, most physicians would suggest other types of screening tests since barium enemas aren't as likely to identify precancerous polyps as sigmoidoscopy, colonoscopy, or CT colonography.

Doctors and specialists

Doctors who specialize in performing colon cancer tests are called gastroenterologists. They are experts in diseases of the stomach and intestines. They have received specialized training in performing colonoscopies and other colon cancer screenings. They'll also be the doctor who would handle your diagnosis and stage your colon cancer.

Is screening free or covered by insurance?

The ACS believes all individuals should be able to receive cancer screenings⁶ regardless of their health insurance status.

The Affordable Care Act (ACA) requires Medicare and private insurers to provide colorectal cancer screening testing⁷ coverage since these tests are suggested by the US Preventive Services Task Force (USPSTF). The law requires that there be no out-of-pocket costs like deductibles or copayments for colon screening testing.

However, the ACA doesn't apply to health insurance plans in place before 2010 (when the law was passed). These are referred to as "grandfathered plans." To see if your health insurance plan is "grandfathered,” you'll need to contact your health insurance provider or the human resources department in your workplace.

Medicaid coverage for colon cancer screening varies by state.

If you have questions about colon cancer screening or think you should undergo one, talk with your doctor.

Take more control over your health by learning about ways to reduce your risk of developing colon cancer.

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