Colorectal cancer screenings: Know all your options

Talk with your doctor about which one is right for you

Doctor and older female patient in medical office looking at computer monitor

Every year, over 100,000 people are diagnosed with colorectal cancer. And though it's the second leading cause of cancer-related death in men and women, there is encouraging news: Screenings are finding colorectal cancer early, and the death rate for this cancer is decreasing.

Colorectal cancer screenings aren't just for older adults. Cases in younger people are rising. And many people don't have symptoms at first. That's why it's important to talk with your doctor about colorectal cancer screening. Together, you can decide which colorectal cancer test is right for you.


Talk with your doctor about screening

Colorectal cancer is one of the most preventable cancers if it's caught early. But because some of the tests require unpleasant prep, many people avoid getting screened.

If you're nervous about colorectal screening, tell your doctor about your concerns. You and your doctor can create a colorectal screening plan that fits your needs.


What is colorectal cancer?

Colorectal cancer is cancer in the colon or rectum. The colon and rectum make up the large intestine, part of the digestive system. Colorectal cancer may also be called colon cancer or rectal cancer.

Colorectal screenings look for polyps and signs of cancer inside the colon and rectum. Polyps are small growths, but they are not cancer. Some polyps can turn into cancer later, so it’s important to find and remove them. 


Screenings for colorectal cancer

Several tests can find colorectal cancer. Your doctor will recommend a test based on your risk of colorectal cancer.

The American Cancer Society recommends everyone begin colorectal screening starting at age 45. But if you have a higher risk, you may need to start earlier and have more frequent screenings. 


Average vs. higher risk of colorectal cancer

You have a higher risk of colorectal cancer if you have any of these risk factors, which include:

  • Family history of colorectal cancer
  • Previous diagnosis of colon polyps or colorectal cancer
  • Inflammatory bowel disease (IBD), which includes ulcerative colitis and Crohn's disease
  • Certain rare inherited conditions, including familial adenomatous polyposis (FAP) or Lynch syndrome 
  • History of ovarian or uterine cancer
  • African American race


Types of tests for colorectal cancer

There are two types of tests for colorectal cancer: at-home screenings and visual tests. Together, you and your doctor can decide which test is right for you.

At-home screenings

If you are at average risk for colorectal cancer, talk to your doctor to decide if an at-home colorectal screening is right for you. These screenings don't involve a procedure or any prep. At-home colorectal tests check for blood in your stool, which can be a sign of colon polyps or cancer.

With these colorectal cancer tests, you collect a stool sample at home. Your provider gives you a kit with supplies and detailed instructions on what to do. Usually, you mail your sample to a lab in a provided envelope or box.

At-home colorectal cancer tests include:

  • Fecal occult blood test (FOBT)
  • Fecal immunochemical test (FIT)
  • FIT-DNA (Cologuard®)

Your doctor may ask you to avoid certain foods, supplements or medicines that could affect your test results. If your results show possible signs of blood in the stool, your doctor will recommend a visual test.

Visual tests

Visual tests allow your doctor to see the inside of the colon and rectum. These tests are helpful for people who have both average and high risk. You and your doctor will decide if a visual test is best for you. Visual tests include:

  • Colonoscopy: Your doctor inserts a thin, flexible tube into the rectum. The tube has a tiny camera that allows your doctor to view the inside of the rectum and colon. Doctors can remove polyps during this test. You will have sedation during the test to keep you relaxed and comfortable.
  • CT colonography: This test uses computed tomography (CT) imaging to see the inside of the colon and rectum. It doesn't require sedation, and doctors don't insert a scope into the colon. However, CT scans expose you to a small but safe amount of radiation. A CT colonography is an option for people who can't have a colonoscopy.

Test prep: Before any of these tests, your doctor will prescribe an enema or laxative to clear your bowel. You usually do this prep at home the day before the test. Your bowel must be empty, so your doctor can see the entire colon and rectum. After you take the laxative, you will have frequent bowel movements and diarrhea. 

Though the preparation for the test can be unpleasant, it lasts only a few hours — and could save your life.


Ways to lower your colorectal cancer risk

You can't control all your risk factors for colorectal cancer. But you can take steps to lower your risk of getting it:

  • Try to move more: Try walking, biking or any activity you enjoy for 30 minutes each day. You can even break it up into 10- or 15-minute chunks.
  • Maintain a healthy weight: Having excess weight raises the risk of getting colorectal cancer. If you carry excess weight, work with your provider to create a weight-loss plan that fits your lifestyle.
  • Talk to your doctor about smoking cessation: Smoking raises the risk of colorectal cancer and other cancers. Quitting can be hard, but help is available. Some health plans offer smoking cessation programs.
  • Ask your doctor about aspirin: Some people may benefit from taking a daily low-dose aspirin to reduce colorectal cancer risk. Ask your doctor whether this is right for you.
  • Aim for healthy food choices: Eat plenty of fruits, vegetables, lean chicken, fish and legumes. You can use these as alternatives to red or processed meats, which can increase the risk of colorectal cancer. Try to cut back on:
    • Beef
    • Lamb
    • Hot dogs
    • Salami
    • Bacon

Shared decision-making is key to colorectal screening

Colorectal screening is important to your health. Together with your provider, you can make an informed decision about which colorectal test works for you.


Sources: American Cancer Society, American Society for Clinical Oncologists, Centers for Disease Control and Prevention

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