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Colorectal cancer screenings

Colorectal cancer is one of the leading causes of cancer death in the United States. Colorectal cancer is frequently diagnosed among senior adults.

Who is at risk

For the vast majority of adults, the most important risk factor for colorectal cancer is older age.

  • Age
  • Family history of colorectal cancer
  • Personal history
  • Inherited risk
  • Alcohol
  • Smoking
  • Race
  • Obesity

Symptoms

There may not be any symptoms, but see your doctor right away if you have any of these:

  • A change in bowel habits, such as diarrhea, constipation, or narrowing of the stool, that lasts for more than a few days
  • A feeling that you need to have a bowel movement that's not relieved by having one
  • Rectal bleeding with bright red blood
  • Blood in the stool, which may make the stool look dark
  • Cramping or abdominal (belly) pain
  • Weakness and fatigue
  • Unintended weight loss

What you can do

  • Exercise
  • Take aspirin
  • Have any polyps removed
  • Eat a healthy diet

Diet and cancer

Colorectal Cancer Prevention

Preventive service at no cost

Adults aged 50 to 75 years

The USPSTF recommends screening for colorectal cancer starting at age 50 years and continuing until age 75 years.

The risks and benefits of different screening methods vary.


Why screening is important

Colon cancer and cancer of the rectum can begin as a small polyp. Often there are no symptoms.

What the screening is

There are several tests that can detect cancer.

Screening Method

Frequency

Evidence of Efficacy

Other Considerations

Stool-Based Tests

gFOBT

Every year

RCTs with mortality end points:
High-sensitivity versions (eg, Hemoccult SENSA) have superior test performance characteristics than older tests (eg, Hemoccult II)

Does not require bowel preparation, anesthesia, or transportation to and from the screening examination (test is performed at home)

FIT

Every year

Test characteristic studies:
Improved accuracy compared with gFOBT

Can be done with a single specimen

Does not require bowel preparation, anesthesia, or transportation to and from the screening examination (test is performed at home)

FIT-DNA

Every 1 or 3 y

Test characteristic studies:
Specificity is lower than for FIT, resulting in more false-positive results, more diagnostic colonoscopies, and more associated adverse events per screening test

Improved sensitivity compared with FIT per single screening test

There is insufficient evidence about appropriate longitudinal follow-up of abnormal findings after a negative diagnostic colonoscopy; may potentially lead to overly intensive surveillance due to provider and patient concerns over the genetic component of the test

Direct Visualization Tests

Colonoscopy

Every 10 y

Prospective cohort study with mortality end point

Requires less frequent screening. Screening and diagnostic followup of positive results can be performed during the same examination.

CT colonography

Every 5 y

Test characteristic studies

There is insufficient evidence about the potential harms of associated extracolonic findings, which are common

Flexible sigmoidoscopy

Every 5 y

RCTs with mortality end points:
Modeling suggests it provides less benefit than when combined with FIT or compared with other strategies

Test availability has declined in the United States

Flexible sigmoidoscopy with FIT

Flexible sigmoidoscopy every 10 y plus FIT every year

RCT with mortality end point (subgroup analysis)

Test availability has declined in the United States

Potentially attractive option for patients who want endoscopic screening but want to limit exposure to colonoscopy


Treatment

The doctor will most likely remove any polyps found. If cancer is found, the treatment plan will depend on how advanced the cancer is. It may include chemotherapy, surgery, immunotherapy,

Additional tips

Prepare to go to have the screening.

Questions to Ask Your Doctor About Colorectal Cancer

Additional Resources