Screening

What do screening tests look for?

colon polyp
Colon Polyp
  • Polyps are common and increase with age. However, not all polyps will develop into cancer.
  • Colorectal cancer (CRC) usually develops slowly over years, usually with little or no symptoms in the early stages.
  • Almost all colorectal cancers develop from a polyp that grows inside the lining of the colon or rectum.
  • If a close family member had pre-cancerous polyps or colorectal cancer, you may need to be screened earlier.

When does colorectal cancer screening begin?

The United States Preventative Services Task Force recommends screening between the ages of 50-75, if you are average risk. The decision to be screened after age 75 should be made on an individual basis. If you are older than 75, talk to your doctor to determine if you should be screened.

There is growing evidence which shows Young Adult Onset Colorectal Cancer (EOCRC) is rapidly increasing. Individuals age 18-40 years of age are in this category. In order to appropriately determine a persons’ risk and to bring awareness about family history and symptoms associated with colorectal cancer, the Colorectal Cancer Prevention Network believes the discussion about risk should begin, at minimum, at age 18.

An informed discussion with your doctor about symptoms, risk and family history should determine when you should be screened and how often. We recommend these conversations should occur annually as factors can change and may impact your screening age. If you are having symptoms, don’t wait! Talk to your doctor.

There are options available to you for colorectal cancer screening if you are average risk, meaning you have no family history of colorectal cancer or pre-cancerous polyps and have no risk factors. You would qualify for stool-based tests and tests that can see inside the colon (direct visualization tests). It is important to know that a positive stool-based test or CT colonography requires a colonoscopy to determine the source of the abnormal findings.

To read more on colorectal cancer screening recommendations, visit the American Cancer Society.


Screening test options for colorectal cancer

Colonoscopy and Fecal Immunochemical Test (FIT) are typically the most commonly offered screenings for colorectal cancer.


Colonoscopy

Appropriate for ALL Patient Risk Levels

Advantages:

Disadvantages:

  • Provides direct visualization of the entire colon and rectum.
  • Detects and removes polyps durring the exam, thereby preventing colorectal cancer development.
  • Provides longer screening intervals.
  • Detects other colorectal related conditions (colitis, diverticulosis, ulcers, hemorrhoids, etc.).
  • Requires caregiver and transportation coordination
  • Time off work
  • Brief dietary and medication adjustments
  • Sedation
  • Risks
    • Perforated colon
    • Polypectomy bleeding
    • Anesthesia complications
video icon

Steve Harvey shared his experience with his colonoscopy. Click here to watch the video.

Visit our resource page to see the CCPN screening program clear liquid diet handout and colonoscopy preparation worksheet.

 

Fecal Immunochemical Test (FIT) and FIT-DNA

For Average Risk Patients Only

These stool-based tests only detect human hemoglobin and are not affected by blood in the upper digestive tract.

Advantages:

Disadvantages:

  • Easy access
  • Low cost
  • Can be done anywhere (home, clinic)
  • No drug or dietary restrictions
  • Non-invasive compared to colonoscopy
  • Average risk only
    • No personal history of colorectal cancer or polyps
    • No rectal bleeding
    • No family history of colorectal cancer or polyps
  • Annual testing is essential to ensure accuracy.
  • Colonoscopy must be completed due to positive FIT.
  • Not all commercial FIT kits are equal (sensitivity and specificity vary).
  • Possibility of false positive or false negative results

 

Visit the United States Preventative Services Task Force to learn more about the evidence on the effectiveness of each screening test, as well as the strengths, limitations and unique considerations for the various screening tests.

checklist icon

Answer a couple questions to see which screening test you need to stay healthy. MyHealthfinder gives you personalized recommendations for screenings, vaccines, and other preventive services.