Colorectal (Colon) Cancer Screening

Colorectal (colon) cancer is a cancer that starts in the colon or rectum. Excluding skin cancers, it’s the third most common cancer diagnosed in both men and women and the second most common cause of cancer deaths when numbers for men and women are combined. It’s expected to cause about 53,010 deaths during 2024 (Source: American Cancer Society). Fortunately, it is also one of the few cancers that is preventable.

Colorectal cancer (CRC) becomes more common as people age. Studies show rates of colorectal cancer among people younger than 50 years are on the rise. As a result, experts and the American Cancer Society have determined that screening starting at 45 years could help save more lives. People at higher risk for colorectal cancer (CRC) because of family history or certain health conditions (such as inflammatory bowel disease) might need to start screening earlier.

“The biggest risk factor for CRC is not having any type of screening and not starting at age 45,” says gastroenterologist Nathan Susnow, MD. with Gastroenterology of the Rockies “We now recommend that patients begin their screenings at age 45, and they continue to age 75 or 85. While CRC overall has decreased in the last 40 years for patients over 50, in part due to CRC screenings, it has increased in those who are younger than 50,” says Dr. Susnow. He added, “It is thought that this uptick in younger patients is related to diet, increased exposure to ultra processed foods, a more sedentary lifestyle and increasing rates of obesity."

Talk to your BCH provider about which screening is right for you.

"Gold Standard" and first-tier option:

A colonoscopy is a 30-minute procedure that uses a high definition (HD) colonoscope, inserted into the colon, to enable physicians to identify any abnormalities, remove polyps before they advance to a cancerous stage and get rid of additional complex polyps. Colonoscopy - which can be both a screening test (find undiagnosed symptoms) and a diagnostic procedure (finds and treats the cause of potential symptoms)- has the highest sensitivity for detecting both cancerous and precancerous lesions, prevents colon cancer by polyp removal and remains the gold standard test. The preps are now easier, the procedure is essentially painless, and with a negative colonoscopy, no other screening is generally needed for 10 years.

A colonoscopy:

• has a 95% detection rate
• detects 3x more advanced lesions than FIT exams,
• 2x more advanced lesions than FIT-DNA (ColoGaurd) exams,
• is the only test that includes polyp removal at the time of the exam,
• risk is minimal, and
• it needs to only be performed every 10-years intervals, significantly less often than other exams.

Colonoscopies also have an exceptionally high detection rate which contributes to higher survival rates as this allows patients to catch colorectal cancer in the early stages. Because of these compelling statistics, a colonoscopy is still considered the gold standard for detecting and preventing colorectal cancer, despite newer at-home tests. If you choose a screening test other than a colonoscopy, like a FIT test (fecal immunochemical test), and the result is positive (abnormal), you will need to have a follow up.

Gastroenterology of the Rockies — part of Endoscopy of the Rockies — was the first group of gastro health specialists in Colorado to use GI Genius™ technology, which is designed to target tissue abnormalities that correlate with colorectal polyps. What sets this instrument apart is that it uses artificial intelligence and carries a 99.7 percent sensitivity rate - helping gastroenterologists see what’s hidden to the human eye.

Second-tier options:

• Guaiac-based fecal occult blood test (gFOBT) and fecal immunochemical test (FIT) are at-home tests used to find tiny amounts of blood in the stool that could be a sign of cancer or large polyps. A positive result will need to be followed up with a colonoscopy. However, these tests often result in false positive or false negative test results. The cause is typically a non-cancerous condition, such as ulcers or hemorrhoids. Stool tests like these need to be done every year. Not FDA-approved for high-risk patients.
• The FIT/Stool DNA test (or Cologuard®) has the advantage of a three year testing cycle. Remember, though, that these tests are not as accurate in detecting precancerous polyps as colonoscopy. They are only designed to detect CRC, not prevent it. A stool DNA test may appeal to people who want to be screened, but don’t want to undergo the usual preparation required for a colonoscopy and some other screening tests. It looks for certain gene changes that are sometimes found in colorectal cancer cells.
  
  The patient uses a take-home kit from their provider's office to collect a stool sample and mail it to a lab. Cologuard® is the name of the stool DNA test that is currently FDA-approved only for non-high risk patients. The test checks for DNA changes that could be a sign of cancer or pre-cancerous growths, or polyps. It also checks for blood in the stool, which can be a sign of cancer. No special diet or bowel preparation is required for a stool DNA test. However, if the test does show a possible cancer or pre-cancer, the patient would then need a colonoscopy to confirm it, and possibly to remove any polyps.
  
  Not everybody can have this type of screening test. It’s only for people with an average risk for colorectal cancer: no personal history of pre-cancerous polyps, colorectal cancer, or some other factors. Ask your doctor if it's right for you.

Third-tier options:

• Flexible sigmoidoscopy is much like colonoscopy, but looks at only part of the colon and rectum. If polyps are found, they may be removed during the test, or you may need to have a colonoscopy later. Bowel prep may be required, but is not as extensive as the one used for colonoscopy. Most people do not need to be sedated during this test. If polyps or suspicious areas are seen, a colonoscopy will be needed to look at the rest of the colon. Flexible sigmoidoscopy must be done every 5 years and should be combined with FIT or FIT/DNA.
• CT colonography (also called virtual colonoscopy) is a scan of the colon and rectum that produces detailed cross-sectional images so the doctor can look for polyps or cancer. It requires bowel prep, but no sedation. Air is pumped into the rectum and colon, and then a CT scanner is used to take images of the colon. If something is seen that may need to be biopsied, a follow-up colonoscopy will be needed. CT colonography must be done every 5 years.

Schedule an appointment

If you want to discuss which screening is appropriate for you, please call your primary care provider, or message them through your MyBCH portal account. To schedule an appointment with your primary care provider, please call 303-415-4015.

To schedule a colonoscopy, please contact Gastroenterology of the Rockies.