Most colorectal cancers occur in people age 50 and older. While colonoscopies are the gold standard for preventing and detecting this disease, one-third of Americans put off getting the test. To improve screening rates, UCLA Health is increasing efforts to educate patients about their options, including colonoscopy and take-home, mail-in fecal immunochemical tests (FIT). Whether you select colonoscopy or a FIT, the most important choice is to be screened. Priyam Tripathi, MD, MPH, a UCLA gastroenterologist in Beverly Hills, shares some important facts.
You have screening options.
The U.S. Preventive Services Task Force recommends that people at average risk of colon cancer begin regular screening at age 50. For those with risk factors associated with colon cancer, screening may need to begin earlier. Colonoscopy remains the screening gold standard to both detect cancer and prevent it by allowing doctors to identify and remove abnormal intestinal polyps before they become cancerous. “Colonoscopy reduces the incidence of colorectal cancer by up to 90 percent,” Dr. Tripathi says. FIT, which checks for blood in stool, is a less invasive stool test alternative to colonoscopy. If a FIT is positive, a follow-up colonoscopy is needed to confirm or rule out a diagnosis of polyps or cancer. While insurance covers colorectal cancer screening including colonoscopies, some patients may opt for short-term anesthesia for colonoscopy, which may result in additional charges. Cologuard is a newer DNA stool test that still is being evaluated as another alternative stool test.
Preparation is key.
It is very important to follow instructions carefully; colonoscopy is much less effective if the preparation is not complete and may need to be rescheduled if the prep is poor. You will receive detailed instructions for the preparation, along with a checklist to ensure that everything is ready for the procedure.
The procedure is not as bad as you imagine.
A colonoscopy typically takes less than 20 minutes. While you are under light sedation, the doctor inserts a flexible tube with a light and small video camera into the colon. If the doctor sees a polyp or other suspicious-looking area, he or she can remove it for further study. “Many patients I talk to after the procedure often say, ‘That’s it?’ They’re in disbelief that it’s over so fast,” Dr. Tripathi says. Following the test, someone should be available to drive you home and stay with you for a few hours afterward until you recover fully from the sedation.
Screening recommendations may vary.
While the U.S. Preventive Services Task Force recommends regular screening starting at age 50, those at higher risk may need to begin earlier. Higher-risk patients include those with a first-degree relative with colon cancer or precancerous colon polyps, a history of inflammatory bowel disease or a genetic condition that is associated with colon cancer. African Americans also are at higher risk and should be screened starting at age 45. It is important to talk about potential risk factors with your physician. For average-risk patients with normal prior tests, a screening colonoscopy is recommended every 10 years. More frequent screening is recommended for patients who have had multiple polyps or other suspicious findings. FIT testing should be repeated annually.
For information about upcoming colon cancer screening events, go to: uclahealth.org/gastro/community-education