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CRC Screening and Prevention

Who should be considered for colon cancer screening?

Colon cancer screening should be offered to any individual at or around the age of 50. Some are screened earlier or more frequently due to family history or personal history of gastrointestinal disease.

What tests exist for colon cancer screening?

Colonoscopy, stool testing for blood, barium enema, and flexible sigmoidoscopy have been available for decades. Newer alternatives for colon cancer screening include CT colonography and stool DNA testing.

Are the newer technologies superior to colonoscopy?

No. While image quality is improving, CT colonography exposes patients to radiation and offers no therapeutic benefit for polyp removal. Additionally, CT does not use any sedation and still requires a prep. Stool DNA testing is not widely available, and its utility has not been established. Colonoscopy remains the optimal strategy for colon cancer screening and prevention. It allows the entire colon to be seen and all visualized polyps removed. Because it is effective at colon cancer prevention, studies have confirmed that colonoscopy reduces both incidence of colon cancer and deaths from colon cancer.

Is colonoscopy perfect?

Colonoscopy is not perfect. Significant polyps can be missed in 6-12% of colonoscopies, and the procedure can result in rare complications. Endoscopic technique and adequacy of bowel prep/cleansing remain focal points of any good colon cancer prevention/screening program.

How does one accomplish adequate colon preparation?

Horror stories exist about colon preps for colonoscopy. Typically a patient will abstain from solids for 24 hours prior to the exam while taking in clear liquids. Traditional large volume purges can be difficult to tolerate due to volume and lack of palatability but still are well tolerated by many. Alternative options exist and can be discussed with a gastroenterology specialist.

How often is a colonoscopy required?

In the absence of colon polyps or family history of early colon cancer, colonoscopy is recommended every 10 years until the age of 80. Typically, if an individual has a few polyps or a 1st degree relative with colon cancer before age 60, a colonoscopy is done every 5 years.

Why are colonoscopies not recommended after age 80?

Cessation of colon cancer screening has been recommended by various professional societies when the risk of colonoscopy exceeds its benefit in terms of colon cancer prevention. These are guidelines and can be adapted to individuals based on personal preference and clinical circumstance.