New Colon Cancer Screening Recommendations

New Colon Cancer Screening Recommendations

Colon cancer screening has been recommended to start at age 50 for many years.  The most common choices for screening are colonoscopy every 10 years, stool DNA tests every 3 years, testing  the stool for blood yearly.  Specific recommendations are made based on an individuals risk assessment which includes their past medical history as well as their family history.  Recommendations look at the likelihood and benefit of finding a colon cancer and try to balance that with the risk and cost of the test. There are several agencies that make recommendations on how to screen for cancer – the U.S. Preventative Services Task Force, American Cancer Society, and American Academy of Family Physicians are the 3 that I usually take into consideration.

The American Cancer Society came out last week with the recommendation that screening for colon cancer start at age 45 instead of 50. This was based on the fact that people are developing colon cancer at an earlier age than they used to.  Screening recommendations vary over time – for example: the flexible sigmoidoscopy used to be a recommended option to be done every 5 years – but this isn’t done as much now since it only allows the doctor to see the left half of the colon, and there has been an increase of cancers on the right side of the colon over time.

It is not uncommon for screening bodies to disagree – for example recommendations for screening for breast cancer and prostate cancer vary across these agencies. There is also  a difference in how strong recommendations are.  The American Cancer Society rates this new recommendation as “qualified” or less strong than their recommendation for screening for those 50-75 yo.  The U.S. Preventative Services Task Force, American Academy of Family Physicians and American College of Gastroenterology currently still recommend starting screening at age 50 for someone who is not at increased risk.  The new recommendations by the American Cancer Society were made after looking at data that showed a trend of cancer developing earlier than it used to.  Click here to get a link to the study. 

It is one thing for an agency to make a recommendation, it is another thing for a patient to get it paid for.  At this time it would be unlikely for insurance companies to pay for a screening colonoscopy in a 45 year-old without other risk factors.  It is also important to remember that these recommendations are about screening tests – which implies that the person doesn’t have any symptoms – no rectal bleeding, abdominal pain, stool changes, etc. that are concerning.  If a person has any symptoms, then it would not be a screening test, but rather a diagnostic test and none of the above recommendations would apply.

While screening 45 year-olds for colon cancer may not be routinely covered at this time, there are behavioral changes people can make to decrease their risk.  Colon cancer is associated with cigarette smoking; excess body weight; a lack of physical activity; and an unhealthy diet, including a lot alcohol and red or processed meat, and lacking fruits/vegetables, dietary fiber  and calcium.  Making these healthy changes can decrease risk of colon cancer and as well as many other cancers and chronic diseases.  If someone believes that they need screening for colon cancer earlier than 50 years-old, it would be a good idea to speak with their doctor.

There are a large number of people in their 50’s who haven’t gotten colon cancer screening yet.  Hopefully by seeing that there is a shift towards recommending screening at an even younger age, people from 50-75 years- old will be more likely to go ahead and get screened and get the benefit of early detection or prevention of colon cancer.

 

***Note *** This post, like all my other posts, is for general medical information only and is not to be taken as direct advice.  Please consult your personal physician for more information.

Colon Cancer Awareness Month

Colon cancer can develop without giving symptoms until it is advanced.  Following screening recommendations can help prevent polyps from developing into a cancer or at least help detect cancer earlier.  Many people avoid screening due to fear, embarrassment, lack of transportation, time or cost.  Many times when a person talks with their doctor they may be able to work through some of these barriers and get tested in a way that works for them.

For most people, it is recommended to get screened for colon cancer starting at age 50.  If someone is at a higher risk based on personal history inflammatory bowel disease,  family history of colon cancer or multiple polyps it may be recommended to start screening much earlier.

The main test I recommend is a colonoscopy.  These tests are done by gastroenterologists, colorectal surgeons or general surgeons.  Colonoscopies may be done in an outpatient center or in the hospital.  It is VERY important to follow the instructions to get ready for this test otherwise the doctor can’t see what they are looking for and things can get missed.  For most people the prep is the most unpleasant part of the test since the procedure itself is generally done under sedation and the patient usually doesn’t remember the test. The specific prep varies from doctor to doctor so if you have had this test before and had a problem with the prep – please let the physician know.

Colonoscopies involve using a endoscope with fiberoptics that the doctor inserts in the rectum up into the large intestine to visualize the whole colon.  This scope is thin – think the width of my pinky finger.

Picture of colonoscope and large intestine

Colonoscopies may be either done as a screening test or to look for a cause of a symptom – like abdominal pain, rectal bleeding, weight loss, anemia, diarrhea or constipation.  If it is done as screening most insurance plans cover this as a preventative benefit.  The frequency of testing varies based on risk factors and the reason for the test.  If it is a screening test and everything comes back fine – usually the recommendation is to get it redone in 10 years.  If there is an abnormal finding during the test, or if the person is at high risk for colon cancer then the test may be repeated in 3 months to 5 years.

Other ways of screening for colon cancer include testing the stool for blood every year, a stool DNA test every 3 years, or a CT colonoscopy, flexible sigmoidoscopy, or a barium enema every 5 years.  If these tests come back positive then the next step is to do a colonoscopy.  This colonoscopy would then be considered a diagnostic test with your insurance and not a screening test and would most likely not be covered as a screening service.  For some people not having to take time off from work to do the test, not having to get a driver to take them to/from the facility, the decreased risk of some alternative tests outweigh the benefit of more definitive and less frequent testing.  In any case it is important to note that a digital rectal exam in the doctors office is NOT enough to assess for colon cancer.  Please contact me to see what is the best way to do your colon cancer screening.

Below is a YouTube video from CNN that discusses colon cancer screening in more detail.

 

***Note *** This post, like all my other posts, is for general medical information only and is not to be taken as direct advice.  Please consult your personal physician for more information.

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