Screening for Colorectal Cancer: What You Need to Know

In recognition of National Colorectal Cancer Awareness Month, Dr. Deborah Korenstein, Senior Medical Director of Mount Sinai Doctors-Concierge Care, provides us with the following information regarding screening guidelines, preventive measures, and risk factors.      

Where Colorectal Cancer Stands Today 

Colorectal cancer is the third most common cause of cancer deaths in both men and women in the US. While diagnoses of colorectal cancer and deaths from colon and rectal cancers have dropped overall, rates among younger people have actually risen for reasons that are not well understood. Fortunately, there are highly effective screening tests that can detect pre-cancerous lesions and remove them before cancer ever develops. The challenge is that the available tests are unpleasant and underutilized, with adequate screening in fewer than 60% of eligible Americans.        

The age at which screening for colorectal cancer is recommended has recently changed and there are several available tests, all of which can be confusing. For people without additional risk factors like inflammatory bowel disease (e.g. Crohn’s), strong family history, or known genetic risk, screening is recommended beginning at age 45 and stopping after age 85 (since there are potential harms associated with screening older people). For people age 75-85, screening decisions are personalized based on overall health.   

What Options are Available for Standard Testing? 

There are two main types of screenings:

   1. Methods for directly examining the colon

• • Colonoscopy, every 10 years  
  • CT colonography, also known as “virtual colonoscopy,” every 5 years

    2. Stool-based tests

• • Highly sensitive tests for DNA or blood in the stool, every year
  • Multi-targeted stool DNA tests (e.g. Cologuard), every 3 years 

Colonoscopy is generally preferred since pre-cancerous lesions or early cancers can be removed during the procedure, thus preventing or curing cancer.  

In addition to these tests, a blood-based screening test for colorectal cancer has recently been approved by the FDA. This test detects circulating abnormal DNA from cancers in a tube of blood. However, it is less sensitive than the standard tests for cancer and extremely poor at detecting pre-cancerous lesions, so it does not enable true cancer prevention. It is not recommended as a standalone screening test. More details from the American Cancer Society can be found online. 

Lifestyle Recommendations

Being physically active, maintaining a healthy weight and avoiding tobacco and excess alcohol can reduce your risk. Diet also matters: eating lots of natural fiber, avoiding processed foods and minimizing red meat can all help.    

Support From Your Provider

Your primary care provider is here for you to discuss your individual risk and the best approach for reducing it. To learn more about screenings for cancer, including colorectal cancer, schedule a visit with your primary care provider.