By age 50, colon cancer is one of the leading causes of mortality in the United States. It is a hugely preventable illness and your doctor can be of great assistance in determining which risk group you belong to and when and how screening should begin. To define some terms:
Fecal Occult Blood Testing—involves taking a stool sample either by doctor’s digital exam or by patient collection and placement on a sample card. A developing liquid becomes positive when placed on the stool sample if blood is present
Sigmoidoscopy—Involves insertion of a tube with a camera on end through the anus that visualizes the last few portions of the colon. This can be done in a doctor’s office without sedation
Colonoscopy—Involves a tube with a camera on end that can visualize the entire colon. This is done in a hospital or same day surgery facility and requires sedation.
Screening Recommendations for Colorectal Cancer and Polyps
Risk Category
Screening Modality
When to Begin Screening
Average Risk
Choose one of the following:
-Fecal occult blood testing annually
-Flexible sigmoidoscopy every 5 years
-Fecal occult blood testing annually and flexible sigmoidoscopy every 5 years*
-Double-contrast barium every 5 to 10 years†
-Colonoscopy every 10 years
50 years
Family History
Choose one of the following:
-Colonoscopy every 10 years
-Double-contrast barium enema every 5 years
40 years or 10 years before cancer was diagnosed in the youngest affected family member, whichever is earlier
Hereditary nonpolyposis colorectal cancer
Colonoscopy every one to three years Genetic counseling Consider genetic testing
21 years
Familial adenomatous polyposis
Flexible sidmoidoscopy or colonoscopy every one to two years Gentic Counseling Consider genetic testing
Puberty
Ulcerative Colitis
Colonoscopy with biopsies for dysplasia every one to two years
Seven to eight years after the diagosis fo pancolitis 12 to 15 years after the diagnosis fo left-sided colitis
*--Some experts recommend combining annual fecal occult blood testing with flexible sigmoidoscopy every five years.
†--Rigid proctoscopy is recommended as an adjunctive examination to allow adequate visualization of the distal rectum. Furthermore, flexible sigmoidoscopy may be necessary to evaluate a tortuous or spastic sigmoid colon.
Information from Winawer SJ, Fletcher RH, Miller L, Godlee F, Stolar MH, Mulrow CD, et al. Colorectal cancer screening: clinical guidelines and rationale. Gastroenterology 1997;112:594-642 [Published errata in Gastroenterology 1997;112:1060 and 1998;114:625].
