The new recommended age to begin colorectal screening is 45 in average risk adults. This is 5 years earlier than the old recommendation and has roughly 21 million people aged 45-49 scratching their heads as to the next steps. We sat down with Dr. Sighinolfi to break down the important information.
Screening Age and Interval
Age 45 is the new recommendation for adults of average risk, however there’s a chance you may want to begin even sooner. If you have a first-degree family history of colon cancer—meaning your parents, siblings, or children have been diagnosed—you will want to begin screening at 40 years of age or 10 years younger than the age at which your family member was diagnosed. Next steps and future screenings will depend on the findings.
Why is colorectal cancer screening important?
Early detection by way of screening is key. It reduces rates of incidence and mortality. Before putting off your colorectal screening, here are some statistics to consider. Colorectal cancer is…
- the 3rd most commonly diagnosed cancer in men and women.
- the 3rd leading cause of cancer related deaths in both men and women.
- expected to cause approximately 53,000 deaths during 2021.
Source: American Cancer Society – Colorectal Cancer Facts & Figures
What are my options for screening?
1. Colonoscopy – During this exam, a small flexible tube with a camera moves through your colon to provide doctors a clear view of the area.
PROS: This method is both diagnostic and therapeutic. This means if a pre-cancerous polyp is found during the examination, it can be removed then and there. If no concerns arise, you don’t have to follow up for another 10 years. An added bonus: Screening colonoscopy is a covered preventive health benefit under the Affordable Care Act. Patients with insurance coverage would not incur any out-of-pocket expenses associated with the colonoscopy screening procedure.
CONS: This method does require a bowel preparation in order to provide a clear view, which nobody enjoys. It is also most often performed with sedation to ensure your comfort during the procedure.
2. FIT Test (Fecal immunochemical test) – This test looks at a stool sample and tests for microscopic blood, which can be an early sign of cancer.
PROS: This method is effective at detecting cancer (but not pre-cancerous polyps) and allows you to avoid the necessary bowel cleanse. It is also inexpensive, comparatively.
CONS: Although the test is able to detect microscopic blood, which can be caused by cancer, it is not a great test for the detection of pre-cancerous polyps. You also have to repeat this test every year. If the test results are positive, you will then be required to undergo a diagnostic colonoscopy and, depending upon your insurance coverage, this may require an out-of-pocket expense.
3. Cologuard – This is a FIT test with the addition of stool-DNA testing. This method detects both blood in the stool and changes in your DNA that indicate cancer or risk of cancer.
PROS: Like the FIT test, this method is good at detecting cancers (but not as good at detecting pre-cancerous polyps) and doesn’t require bowel prep.
CONS: Cologuard is more expensive than the FIT test and must be completed every 3 years. Like the FIT Test, if the results show reason for concern, you will then require a diagnostic colonoscopy to further investigate the source of the positive test. In addition, depending upon your insurance coverage you are likely to incur an out-of-pocket expense for the diagnostic colonoscopy procedure.
What’s my best option?
Dr. Sighinolfi recommends colonoscopies as the best, tried and true screening method. Not only does the test offer the best sensitivity and specificity, but it allows the doctor to remove pre-cancerous polyps during the procedure—polyps that the other tests may not detect. In addition, if the FIT test or Cologuard are positive, a follow up diagnostic colonoscopy will be the next step.
Although there are some associated risks, colonoscopies are incredibly safe overall. Dr. Sighinolfi adds that the bowel preparation is well worth the peace of mind that comes with a thorough screening examination and can potentially eliminate the need for repeat screening for another 10 years.
Is it time for your colorectal screening? Contact your primary care provider for a referral or to discuss which option is best for you.
