Colorectal Cancer Screening for Adults (50 and up)
adapted from Lab Tests Online® (www.labtestsonline.org) Colorectal cancer is the third leading cause of cancer deaths in the U.S. – and one third of these deaths could be prevented with regular screening. Cancer of the colon and rectum is both preventable and treatable if detected early. Colorectal cancer can be prevented by looking for and removing polyps and lesions in the colon. These are found most often in people 50 years of age and older, so experts (including the CDC, the Agency for Healthcare Research and Quality, and the American Cancer Society) recommend universal screening in this age group: Adults 50 years of age and older who are of average risk should be routinely screened for colorectal cancer. Earlier, more frequent, and the most rigorous screening is appropriate at a younger age for those who have risk factors, often beginning at age 40. Americans of African descent should get screened starting at 45 years of age. African-Americans tend not only to be diagnosed with this cancer at a younger age but also to survive for a shorter period of time. When to stop screening The U.S. Preventive Services Task Force recommends against routine screening in people 76 to 85 years of age who have had consistently negative screenings since they were age 50, and in all people over the age of 85. Which test should you have? Recommended colon cancer screening tests fall into two categories:. Lab tests find telltale blood or DNA—signs that cancer is present—in a stool sample. The three types of lab tests are the fecal occult blood test, the immunochemical fecal occult blood test, and the stool DNA test. Imaging procedures show abnormalities—polyps and lesions—on the empty colon’s lining. Two of these use a scope with a video camera: colonoscopy views the entire length of the colon, and flexible sigmoidoscopy views the lower third. The other two use x-rays: virtual colonoscopy—a computed tomography (CT) scan—combines many cross-sectional images into 2-D and 3-D views of the colon, and a double-contrast barium enema (DCBE) provides x-ray views of lumps, polyps, and abnormalities in the outline of the colon. Current guidelines urge getting a screening test good at finding both cancer and polyps, provided a procedure of this type is available to you and an invasive test is acceptable to you. They recommend relying more on the tests that can help prevent cancer rather than tests that only detect it. No single test is preferred for all individuals. Any one of the recommended approaches described below can be appropriate for a person of average risk, depending on the circumstances. The first four can find both polyps and cancer: Flexible sigmoidoscopy every 5 years Colonoscopy every 10 years Double-contrast barium enema every 5 years Virtual colonoscopy every 5 years Particularly when the ease and safety of a sample-based test is desirable, one of the three lab tests can be used: Fecal occult blood test (FOBT) or the simpler immunochemical fecal occult blood test (iFOBT or FIT) every year Stool DNA test—optimal frequency not yet known; USPSTF found that not enough information was available yet for it to make a recommendation on use of this test. Each test can be used alone, or two test types can be used in combination. When the findings are abnormal, a colonoscopy is needed. Colonoscopy is the most accurate and thorough test but also the most costly and invasive; it is especially appropriate for those with risk factors. You may have reasons to choose a simpler test. Stool sample and sigmoidoscopy tests are easier but not as accurate; they are better used together and can be the best approach in specific situations. As the U.S. Centers for Disease Control and Prevention notes, any of the recommended tests is better than no test. Research is showing that attention needs to be paid not only to polyps but also to flat lesions on the colon’s lining. This may further influence the types of tests recommended. It also means the person viewing your images must work more carefully than ever. Decision aids Talk to your health care provider about the screening tests recommended for you. If you are enrolled in any of Dow’s Aetna Medical Plans, many of these tests are covered at 100% with no deductible, providing you use an in-network provider or you live out-of-area. Check your Summary Plan Description or call Aetna at 1-800-7DOWDOW for details.