When to get a colonoscopy - do you know your number? 

Content warning: discusses cancer and mentions death

Let’s talk colorectal cancer. The rates of colorectal cancer are increasing. So much so that the recommended age to begin screening for colorectal cancer has decreased for the general population - from age 50 to age 45. 

Colorectal cancer is the second most common cause of cancer deaths when numbers for men and women are combined (source: cancer.org.) Everyone needs to get screened, but the age that you should start screening can vary based on your risk. 

Risk factors for colorectal cancer include positive family history (FH) and/or personal history of colorectal cancer, precancerous polyps, or inflammatory bowel disease - crohn's disease or ulcerative colitis; obesity, physical inactivity, high consumption of red/processed meats, low consumption of fruits/vegetables, averaging 2-4 alcoholic beverages per day and smoking tobacco (source: coloncancercoalition.org).

Average risk: begin screening at age 45 (source: cdc.gov) 

Advanced risk: it depends! If you’re at increased risk of developing colon cancer because you had a first degree relative that was diagnosed with colon cancer, then you should begin screening 10 years younger than the age of your first degree relative when they were diagnosed. Your parents and siblings are first degree relatives. 

Average risk	45
Advanced risk (+FH)	10 years before the age at which your first degree relative was diagnosed or 45, whichever is sooner

• Remember: death does NOT equal diagnosis. If you lost a loved one to colon cancer, then I’m sorry and you’re not alone. I’ve lost several and am at increased risk myself. 

• Factor in such details as when the diagnosis was made, how advanced the disease was at the time of diagnosis, and how long the affected underwent treatment or battled the disease before they died.

• AN OUNCE OF PREVENTION IS WORTH A POUND OF CURE. If you are uncertain of the age of your first degree relative at the time of diagnosis, then gather as much information as you can to try to pinpoint it. It’s better to err on the side of caution and estimate a younger age to start screening sooner rather than later. Colon cancer can be prevented or very treatable if it is detected early. 

• Please DO NOT live by the old adage: "if it ain't broke, don't fix it." If you wait until you have symptoms (blood in stool, changes in stool habits, abdominal discomfort, anemia, fatigue, weight loss - source mayoclinic.org) the disease is often already established and advanced. At that point, a colonoscopy is for diagnosis and staging to determine treatment options, rather than screening and prevention. 

If you are at increased risk for colorectal cancer due to having many risk factors, then initiate a conversation with your primary care provider (PCP) to determine if screening sooner than age 45 may be appropriate for you. This is a scenario where it's not necessarily good to be "better late than never." 

In the meantime, do your best to lower your risk by addressing the modifiable risk factors (things you CAN change): alcohol and smoking cessation, consuming more fruits/vegetables and less red/processed meats, increasing physical activity and losing weight if you're overweight/obese.

Now that you know your number, the age at which you should be screened for colorectal cancer (or how to go about finding it), the next step is to see your PCP.

What are the options to screen for colorectal cancer?

• Colonoscopy* is the gold standard if you’re at average or high risk. 

• Cologuard and FOBT (fecal occult blood test) are alternative less invasive options that can be considered if you’re at average risk.

• Please do your own research and discuss with your PCP the limitations  of alternative screening tools. There is risk for false positive and false negative results. And many scenarios can exclude you from being an appropriate candidate for these tests. 
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• Check out this ABC news article for more colorectal cancer screening method comparison. 

Why is colonoscopy the gold standard colorectal cancer screening method?! 

This is important! Colonoscopy is the gold standard, because the tissue of the colon is being visualized directly, and it can be both diagnostic AND therapeutic. That means that if any polyp is detected during the colonoscopy, then it can be removed at that time to be sent for pathology testing. 

A precancerous polyp cannot become cancer if it's removed! Of course, there can be other positive findings. The colonoscopy and the findings provide more information regarding your particular risk profile, and informs the plan in terms of repeat testing in the future, or current treatment if further intervention is required.

What about the alternative screening methods?

If you have a positive Cologuard or FOBT, then guess what the next step is? 

GET A COLONOSCOPY!

As previously mentioned, I myself am at increased risk of colon cancer. My father died from complications of colon cancer when he was only 45, so I had my first screening colonoscopy in my early thirties. 

Unfortunately, my father was younger than the recommended routine screening age of 50 at that time. Speaking as a medical provider, it seems we are trying to achieve more and more during shrinking appointment times - we often can't address everything on "the list." Certainly preventative medicine is on our minds, and we even have the aid of electronic medical records to prompt alerts when a client is due for certain screenings and interventions. 

But as you can see, the recommended universal screening age doesn't catch everyone. This is why it's so important to know the age at which YOU should start screening if you know it differs from the recommended guideline. That way this "problem" can be at the very top of your list to discuss with your PCP. Again, an ounce of prevention is worth a pound of cure! And certainly if you develop any of the aforementioned symptoms that could be indicative of colorectal cancer, then don't delay seeking medical counsel. 

Do you know your number, or have you already been screened for colorectal cancer? Let me know in the comments!

Be sure to come back next Monday when I post about my experience with the colonoscopy preparation and procedure. 

**This post does not contain affiliate links, nor is it a sponsored post.