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Colon & Rectal Screenings

 
Colorectal Cancer Screening Guidelines
If you are at average risk

The American Cancer Society recommends that individuals at average risk of colorectal cancer start regular screening at age 45. This can be done via a colonoscopy (an exam that looks at the colon and rectum), or with a sensitive test that checks for signs of cancer in a person’s stool 

People in good health with a life expectancy of more than a decade should have regular colorectal cancer screening through age 75.

For those 76 through 85, screening should be based on personal preference, overall health, life expectancy, and screening history.

Colorectal cancer screening is not recommended for people over 85.

People are considered to be at average risk if they do not have:

  • Certain types of polyps or a personal history of colorectal cancer
  • Family history of colorectal cancer
  • Personal history of inflammatory bowel disease, such as Crohn's disease or ulcerative colitis.
  • Confirmed or suspected hereditary colorectal cancer syndrome, such as Lynch syndrome (hereditary non-polyposis colon cancer) or familial adenomatous polyposis.
  • Personal history of getting radiation to the pelvic area or abdomen to treat a prior cancer
Colorectal cancer screening options


Stool-based tests

  • Multi-targeted stool DNA test (mt-sDNA) every 3 years
  • Highly sensitive fecal immunochemical test annually
  • Highly sensitive guaiac-based fecal occult blood test annually
Visual (structural) exams of the colon and rectum
 
  • Colonoscopy every 10 years
  • Flexible sigmoidoscopy every 5 years
  • CT colonography every 5 years

The most important thing is to get screened, regardless of  which test you choose. Talk to your doctor about which test is right for you as well as which tests are covered by your insurance.

If a person elects to be screened vian anytest other than colonoscopy, an abnormal test result should be followed up with a colonoscopy.
 

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If you are at increased or high risk

People at increased risk of colorectal cancer may need colorectal cancer screening prior to age 45, be screened more frequently, and may require specific tests. This includes people with:

  • Strong family history of certain types of polyps or colorectal cancer
  • Personal history of certain types of polyps or colorectal cancer
  • Personal history of inflammatory bowel disease, such as Crohn's disease or ulcerative colitis
  • A known family history of a hereditary colorectal cancer syndrome such as Lynch syndrome (also known as hereditary non-polyposis colon cancer) or familial adenomatous polyposis  
  • Personal history of radiation to the pelvic area or abdomen to treat a prior cancer

The US Multi-Society Task Force on Colorectal Cancer provides screening guidelines specifically for people at increased or high risk of colorectal cancer. The guidelines categorize people into several groups, although the details depend on an individual’s specific risk factors.

People at increased risk for colorectal cancer
People with family members who have had colon or rectal cancer

Screening recommendations this group depends on who in the family had cancer and their age when it was diagnosed. Some patients with a family history may be able to follow the recommendations for average risk, but others might need to get a colonoscopy more frequently,  possibly before age 45.

People who have had certain types of polyps removed 

Most patients in this group will need to get a colonoscopy again after three years, but some people might need to get one earlier (or later), depending on the  size, type and number of polyps.

People who have had rectal or colon cancer

Patients in this group will require regular colonoscopies beginning about one year after the removal of the cancer. Other procedures like proctoscopy with ultrasound or MRI may also be recommended for some patients with rectal cancer.

People who have had radiation to the pelvic area or abdomen or pelvic area

Most patients in this group will require colorectal screening at an earlier age. Screening often begins five years after the radiation treatment or at age 30, whichever comes last. This group might also require more frequent screening.
 

People at high risk for colorectal cancer
People with inflammatory bowel disease

Patients in this group generally require colonoscopies beginning at least eight years after the diagnosis of inflammatory bowel disease. Additional colonoscopies should follow every one to three years, depending the findings of the previous colonoscopy or the risk factors for colorectal cancer.

People with certain genetic syndromes

People in this group generally need to have colonoscopy. Screening is often recommended as early as the teenage years for some syndromes – and is needed more frequently. Specifics depend on the specific genetic syndrome and other factors.

Talk to your doctor if you think you might be at an increased or high risk of colorectal cancer. Based on your indiviual risk, your provider can help determine the best screening option for you, as well as the screening schedule you should follow.

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