Colorectal Cancer (CRC) is a common and lethal disease. It is estimated that 100,000 cases of CRC are diagnosed in the US annually. Approximately 53,000 Americans are expected to die of CRC every year. Although the mortality rate of CRC is decreasing, it remains the third most common cause of cancer-related death in women and the second most common in men.
Although the incidence of CRC in patients over 50 has been decreasing, CRC incidence in patients aged 40-50 has been increasing. The US Preventative Services Task Force recommends screening for average-risk African Americans at age 45.
The type of screening should be a shared decision between the patient and the GI specialist. Colonoscopy, which is recommended by most GI MD’s is the only screening test proven to decrease CRC mortality. Optimally, this procedure should be performed at 50 in average-risk patients, and if negative, repeated every ten years.
Fecal Immunochemical Testing (FIT) is a stool test done annually and is recommended in patients unable or unwilling to have a colonoscopy. If the FIT result is positive, a colonoscopy must be performed by a GI specialist. FIT is comparable to colonoscopy in the detection of CRC but has a lower detection rate for advanced adenomas, which may harbor localized cancer.
Computed Tomography Colonography (CTC) is an option for patients at risk of complications from sedation or the procedure itself. CTC requires a colonoscopy laxative preparation and is done without sedation. It is relatively sensitive in identifying large polyps, which, if seen, would require a colonoscopy.
Stool for guaiac fecal occult blood is insensitive and requires multiple stool samples. This test has been largely replaced by more specific stool tests (FIT). Most importantly, any option is better than nothing. Many patients believe that without abdominal pain, change in bowel habits, or rectal bleeding, the risk of developing colon cancer is very low. Most patients found to have colon cancer are asymptomatic and average risk. Discussion with a GI specialist will help determine the best option.