Rethinking Colorectal Cancer and Colon Cancer Screening: What Women Should Know
By: Taryn Smith, MD • Posted on March 01, 2019
March is National Colorectal Cancer Awareness month and as one of the most common cancers in both women and men it is time to focus on what you can do to screen for and hopefully prevent colorectal cancer.
So, you have probably heard stories about the dreaded colonoscopy preparation. Or maybe you have found yourself avoiding a colon cancer screening altogether after hearing any of the following myths:
- I only need to be screened if I am having symptoms - FALSE
- Colonoscopy is my only option for colorectal cancer screening - FALSE
- Colonoscopy is a painful process - FALSE
- Women don’t get colorectal cancer - FALSE
- I’m healthy and have no family history of colorectal cancer, so I do not need to be screened - ALSO FALSE
If any of these thoughts have gone through your mind, then it’s time to learn the truth about colorectal cancer screening.
What is Colorectal Cancer?
Colorectal cancer refers to cancers affecting either the colon and/or the rectum. It is the second leading cause of cancer-related deaths in both men and women in the United States. Approximately, 1 in 20 women are at risk of developing colorectal cancer in their lifetime. Due to advances in screening, death rates from colorectal cancer continue to decline. However, while they are declining, incidence in younger people is on the rise!
What Symptoms to Look Out For
More than half of people with colorectal cancer had NO symptoms at the time of diagnosis. Several symptoms can actually signal the presence of colorectal cancer. These symptoms include:
- A persistent change in bowel habits (narrow/pencil thin stools, constipation, diarrhea)
- Sensation that you cannot fully empty your bowels
- Abdominal (belly) cramping or pain
- Dark, black or bloody stool
- Weight loss for no apparent reason
- Excessive weakness or fatigue
Who Should be Screened for Colon Cancer?
The American Cancer Society recommends routine screening beginning at age 45 for the average risk person while the US Preventative Services Task Force recommends starting at age 50. African Americans should start screening at age 45.
Most insurance plans will cover all or a portion of expenses related to colorectal cancer screening in individuals 50 and over. After age 75, the need for routine screening is based on several factors including the findings at previous examinations and your overall health. It is always important to see your physician for a personalized assessment.
Populations With a High Risk of Colon Cancer
Colorectal cancer is more common in smokers and individuals who are overweight/obese, sedentary and eat a diet high in fat from animal sources. You are considered to be at an increased risk for colon cancer, if you have the following:
- A personal or family history of colon cancer
- Known colon or rectal polyps on prior exams
- Inflammatory bowel disease
- You have a known hereditary genetic mutations associated with colorectal cancer that runs in your family. Such hereditary conditions (e.g. Lynch syndrome) are associated with cancers besides colorectal, such as endometrial, stomach or ovarian. Women with BRCA1 may be at risk for earlier colorectal cancer.
If you are at high risk, talk to a health care professional regarding when to start screening.
Colon Cancer Screening Options
Screening options are divided into two categories:
1. Stool Based Tests
Stool based tests require no advanced bowel preparation and can be done in the comfort of your home. These tests may be a good option for the low or average risk population. A fecal immunochemical test (FIT) is an example of a stool based test. If a stool based test is abnormal, the next step is often direct visualization on the colon.
Stool Based Screening Tests
- Yearly fecal immunochemical test (FIT)
- Multi-targeted stool DNA test (also known as Cologuard) every 3 years
- Yearly fecal occult blood test
2. Visual Tests
Visual tests such as colonoscopy involve looking into the colon and rectum with an endoscope. This allows abnormal areas to be visualized or even removed at the time of the screening exam. Colonoscopy requires a bowel preparation the night before the procedure. Golytely and MoviPrep are the most common bowel preparations used, but many others exist. Ask your primary care doctor or Gastroenterologist about your options. The U.S. Multi-Society Task Force on Colorectal Cancer has ranked screening options based on performance features, costs and practical considerations.
Visual Screening Tests
- Colonoscopy if normal every 10 years
- CT colonography every 5 years
- Flexible sigmoidoscopy every 5 years
Given the new advances in technology, we now have several options for colorectal cancer screening. Colonoscopy remains the gold standard for colon cancer screening due to is ability to visualize abnormal areas and immediately remove them before they become cancer. Talk to your doctor about your risk and decide what screening option is best for you. Colon cancer screening and early colon cancer detection saves lives.
Be Strong. Be Healthy. Be in Charge!
-Taryn Smith, MD