Exploring the Latest Innovations in Colon Cancer Screening: A Comprehensive Guide
As a gastroenterologist, I often get asked “when should I start getting screened for colon cancer?” This is an important question, as colon cancer is one of the most preventable yet deadly cancers. The good news is that with proper screening, we can detect precancerous polyps and early stage colorectal cancers when treatment is most effective.
What are the screening tests for colon cancer?
The main screening modalities are structural exams that allow us to visually inspect the colon. This includes colonoscopy, which uses a tiny camera on the end of a flexible tube to examine the entire colon and rectum. It remains the most sensitive test, allowing for detection and removal of precancerous polyps in the same exam. We can also perform CT colonography, which uses CT imaging to construct a 3D model of the colon. Finally, we have options like the FIT stool test and Cologuard stool DNA test to screen for cancerous or precancerous cells shed into the stool. These tests must be paired with a follow-up colonoscopy if abnormal.
Colon cancer screening guidelines
The timing and frequency of screening depends on your individual risk. For average risk adults, screening should begin at age 45 with either a colonoscopy every 10 years or an annual FIT or Cologuard test every 1-3 years. Those with a family history may need to start sooner and screen more often. In general it is recommended that those at higher risk preferentially perform screening with high quality colonoscopy.
Colon cancer family history guidelines
If you have a first degree relative (parent, sibling or child) diagnosed with colon cancer or two second degree relatives diagnosed with colon cancer, you are at high risk. You should get your first colonoscopy 10 years before the youngest diagnosis in your family, or by age 40, whichever comes first. After that, you’ll need a colonoscopy every 5 years.
When to get screened for colon cancer
I generally recommend patients schedule their first screening colonoscopy at age 45 if they have no other risk factors. This gives us the chance to establish a baseline examination of the colon and remove any existing polyps before they ever progress to cancer. By screening people earlier, studies show we can drastically decrease colon cancer incidence and death.
From there, frequency of screening depends on what we find during the initial and subsequent exams. If there are no polyps, the next colonoscopy can be performed up to 10 years later. If precancerous polyps are found (often called "adenomas"), you may need a repeat exam in 3 to 5 years depending on size, number and pathologic features. Lastly, if you have a strong family history or inflammatory bowel disease, more frequent exams are recommended.
Advantages of colonoscopy compared to other methods
Colonoscopy offers a couple distinct advantages over other screening modalities. As mentioned, it visualizes the entire colon - no other test does this as well. Small or flat lesions can be easily missed by CT colonography or stool tests. Additionally, we can remove precancerous polyps during the same procedure using tiny instruments passed through the colonoscope. No need to schedule a separate procedure! This prevents the polyp from becoming cancerous down the road.
Finally, if we do find cancer, biopsies can be obtained to determine depth of invasion and look for high risk features. This allows better staging and aids in determining optimal treatment strategies. For these reasons, colonoscopy remains the gold standard. It is however an invasive test that requires prep and sedation, which can serve as barriers to screening for some patients. If you have any questions or concerns about this life-saving procedure, don't hesitate to reach out to our office!
Colon Cancer Screening Guidelines for Those at High Risk
Certain individuals may need to start screening earlier and undergo colonoscopy more frequently. This includes those with a strong family history as noted above. It also includes patients with long standing inflammatory bowel disease involving extensive colitis. The chronic inflammation predisposes to dysplasia and colon cancer, warranting close surveillance.
Those with genetic syndromes are also at considerably higher risk. Lynch syndrome, also known as hereditary nonpolyposis colorectal cancer (HNPCC), increases risk 20-fold. Likewise, those with familial adenomatous polyposis (FAP) may develop hundreds of precancerous polyps starting at a young age. Anyone suspected of having these genetic conditions should meet with a gastroenterologist by age 20, and may need annual exams thereafter.
As you can see, screening and surveillance guidelines are quite nuanced. They depend on your personal and family history, previous findings, genetic makeup and other medical conditions. Having an in-depth discussion with your gastroenterologist is imperative so that together you can develop a customized prevention plan.
Time to Schedule Your Screening Colonoscopy
If it's been awhile since your last colonoscopy, or if you've never been screened, it's time to schedule an appointment with a gastroenterologist. I recommend contacting my office to set up a consultation, or reach out to any physician specially trained in colon cancer screening. Those due for screening, or with a family history warranting earlier and more frequent exams, should prioritize making that appointment.
When choosing a facility, look for ones like Digestive Health Centers of Texas that have exceptional quality metrics, high adenoma detection rates, and gastroenterologists focused on providing a comfortable, patient-centered experience. The right physician and center can help ensure you have a smooth, effective screening or surveillance colonoscopy.
The Future of Colonoscopy - AI to the Rescue
An exciting area of research aims to increase adenoma detection rates during colonoscopy through AI or computer-aided diagnosis (CAD) technology. By leveraging computational power and deep learning algorithms, imaging analysis software can highlight suspicious lesions in real time to assist endoscopists.
Recent studies have shown CAD for colonoscopy can boost adenoma detection rates by over 14%, helping us find more precancerous polyps during screening exams. Together with advancements in endoscope optics, molecular biomarkers, and competency-based training and quality assurance, adding AI to the mix should further improve the capabilities of colonoscopy to prevent colorectal cancer deaths through early detection.
As always, speak with your doctor to determine when you should begin screening and how often you need to undergo examinations based on your risk factors. Colon cancer is preventable with proper screening - don't delay making that appointment! I look forward to seeing you in my practice soon.
DISCLAIMER: Please note that this blog is intended for Informational Use only and is not intended to replace personal evaluation and treatment by a medical provider. The information provided on this website is not intended as a substitute for medical advice or treatment. Please consult your doctor for any information related to your personal care.