Colorectal Cancer Screening and Prevention

Colorectal cancer is the second leading cause of death from cancer in the U.S. While people over 50 are at the most risk, young adults are at increasing risk. Rates of colorectal cancer have been rising among people ages 20–49. This is likely linked to an unhealthy lifestyle and being overweight or obese. 

Preventable, treatable and beatable!

Many cases of colorectal cancer can be prevented with a healthy lifestyle, and with routine colonoscopy to find and remove polyps, which could turn into cancer. Screening with colonoscopy should begin at age 50 if you are “average risk”, age 45 for African Americans, and possibly a younger age for those with family history of colon or rectal cancer in parents or siblings.  

Colorectal cancer is also very treatable, especially when found in its early stages. Screening tests can help detect it.

Decrease your risk:

  • Talk to your doctor about your personal risk. Your overall health, lifestyle and family history all play a role. Learn how to decrease your risk with a healthy lifestyle, below.
  • Get screened. Keep reading to learn when you should start. 
  • Know – and don't ignore – the warning signs of colorectal cancer. Keep reading to learn what they are.

  1. Preventing colorectal cancer

    What's Getting Into You? event April 2013A healthy lifestyle is one of the best ways to help prevent colorectal cancer, and many other kinds of cancer, too. One large study has shown that by doing just three things you can reduce your risk for colorectal cancer by 37 percent:

    * Eat a healthy diet
    * Maintain a healthy weight
    * Do not smoke

    To help prevent colorectal cancer:

    • Don’t smoke.
    • Drink in moderation. Stick to two or fewer drinks per day – drinking more increases your risk of colorectal cancer and also of benign tumors (and breast cancer).
    • Maintain a healthy weight.
    • Eat a healthy diet – lots of fruits and vegetables, and limited red meat. Avoid processed meats (like bacon, ham and salami).
    • Consider aspirin. An aspirin every day for five years or more decreases the risk of colorectal cancer and the risk of death from colorectal cancer. In a study of women, taking aspirin every other day for 10 years decreased the risk of colorectal cancer. Talk with your doctor before doing this – there can be side effects.
    • Make sure you get enough Vitamin D. Some research links low levels of Vitamin D and colorectal (and breast) cancer. Many people in the Northwest don't get enough Vitamin D.
    • Take care of those polyps. Most colorectal polyps are adenomas, which can turn into cancer. Removing colorectal polyps that are larger than 1 centimeter (cm) may lower the risk of colorectal cancer. Polyps are found and removed during a colonoscopy.

    The anti-cancer diet

    Eat 5-10 servings of fruits and vegetables every day One half of your plate should be fruit and vegetables. 
    Foods that decrease cancer risk:
    Fish, whole grains, vegetables (especially cabbage, kale, broccoli, bok choy, cauliflower, Brussels sprouts), fruits, nuts, legumes (beans, peas)
    Foods that increase cancer risk:  Meats, saturated fats, dairy, sugar, white flour (white bread and pasta), alcohol
  2. Screening guidelines: Who and when

    The general recommendation is to start at age 50. But there are exceptions.

    If you are:   Start screening:
    Caucasian, Hispanic or Asian At age 50 
    African-American At age 45
    If you have:  Start screening:
    A blood relative who had colorectal, ovarian or uterine cancer
    At age 40 or 10 years before your relative was diagnosed, whichever comes first
    Risk factors including inflammatory bowel diseases, Crohn's disease or ulcerative colitis, or a history of colorectal polyps
    Talk with your health care provider about when you should start screening
  3. Colonoscopy: The gold standard

    Dr. Joe Frankhouse, Legacy colorectal surgeon

    "Colonoscopies are one of the few screening tests that actually help prevent the disease."

    - Colorectal surgeon Joseph Frankhouse, M.D.

    A colonoscopy can prevent cancer, because during the colonoscopy, your doctor can see and remove polyps, which may turn into cancer. 

    And it's really not as bad as you think - you sleep right through it. (It's the prep that scares off people, and that is better than it used to be - really!)

  4. Other screening options

    Legacy Cancer Institute recommends colonoscopy, because it is the only screening test that can actually prevent cancer. It does this by finding and removing polyps, which may turn into cancer if left in place.

    However, there are other screening options.

    Talk with your health care provider about the best choice for you:

    • Colonoscopy – Colonoscopy is the most accurate and complete of the screening test options, and is performed with the patient under mild sedation. A colonoscope, a long, slender, flexible tube with a lighted end, is inserted into the colon through the rectum. This allows the physician to look at the entire colon and to snip polyps or tissue for biopsies if anything looks suspicious. 
    • Stool blood test – Small samples of stool are tested for any traces of blood. The stool is collected by you at home, with an “immunochemical” fecal occult blood test kit (also called a “FIT” test); it is returned to the lab for testing.
    • Flexible sigmoidoscopy – This test is like a colonoscopy but looks only at the lower portion of the colon; it does not require sedation. A sigmoidoscope, a slender, flexible tube with a lighted end, is inserted into the colon through the rectum. It allows the physician to look at the lower portion of the colon. Polyps or suspicious tissue can be snipped for biopsy.
    • Double contrast barium enema – A chalky liquid and air are pumped into the colon through the rectum, which makes the colon expand. X-rays of the colon and rectum are then taken. 
    • CT colonography (computed tomographic colonography, also known as "virtual" colonoscopy) – Air is pumped into the colon through the rectum and a special X-ray equipment (a CT scanner) takes pictures of the colon and rectum from outside the body. Medicare and some insurance companies may not pay for the costs of this procedure.  If abnormal growths are seen, a regular colonoscopy may be recommended.  
    • Stool DNA test – This newer stool test, currently called “Cologuard®”, looks for blood and genetic markers for colorectal cancer.  Although this test is approved by the FDA, it is still being studied for usefulness and accuracy; also it is expensive and may not be covered by insurance.  The stool sample is collected at home and sent to a lab for testing.  If the results are abnormal a follow-up colonoscopy is recommended.  This test is for people with an average risk for colon cancer, with no personal history of pre-cancerous polyps, colon cancer, or certain other colon problems. Ask your doctor if this test is acceptable for your personal risk situation.

    For more information about screening tests:  www.cancer.gov/types/colorectal/screening-fact-sheet

  5. How much does it cost?

    For many people, screening costs nothing or very little. However, it's a bit complicated. The table below explains. 

    Colonoscopy

    With insurance: Without insurance: 
    Screening colonoscopy is covered 100% by insurance. This includes polyp removal, according to federal regulators. (We recommend you double-check with your insurance plan before your appointment.) 
     If you have to pay for all of it yourself, plan on between $2,000 and $3,000.
    If you have any signs or symptoms (like bleeding or a change in bowel habits), the colonoscopy will be considered diagnostic. That means you will be charged any insurance co-pays and/or deductible.
     

    Take-home fecal blood tests (FIT, iFOBT, FOBT)

    With insurance:
    Without insurance:
    The FIT (or iFOBT) and the FOBT, are considered screening tests, and are 100% covered by insurance. 
    Under $50
    However, if the FIT/FOBT results indicate anything suspicious, your doctor will likely recommend a colonoscopy. At that point, the colonoscopy is considered diagnostic. You will be charged for your insurance co-pays and deductible amounts.
    However, if the FIT/FOBT results indicate anything suspicious, your doctor will likely recommend a colonoscopy. If you have to pay for that yourself, count on $2,000-$3,000. 
  6. Six symptoms you shouldn't ignore

    Colorectal cancer often has no symptoms, which is why screening is so important. However, as it advances, there can be signs. If you have any of symptoms, tell your health care provider right away.

    Don't ignore these symptoms:

    • Unexplained changes in bowel habits that last for more than a few days, including diarrhea or constipation
    • The urge to have a bowel movement that is not relieved once complete
    • Bleeding, or stools that are dark or contain blood. However, sometimes stool may still look normal
    • Pain or cramping in the abdomen
    • Unexplained weakness or fatigue
    • Unplanned weight loss

     

    These may be signs of other conditions, including infections, hemorrhoids, irritable bowel syndrome, or inflammatory bowel disease. However, if you are experiencing any of these symptoms, don’t wait to call your doctor so the cause can be found and treated as soon as possible.