Screening Guidelines: March is Colorectal Cancer Awareness Month

By K. Agyei-Gyamfi, MD

Gastroenterologist Dr. Kwadwo Agyei-Gyamfi is affiliated in private practice with Acme Medical Specialties in Lumberton and is a member of the UNC Health Southeastern Medical Staff

According to the American Cancer Society, colorectal cancer is one of the leading causes of cancer death in men and women. Colorectal cancer is preventable and screening can reduce mortality. Screening is the best way to do that. It is very important you know your risk!

Who is at average risk?:

• A personal history of colorectal cancer or certain types of polyps
• A family history of colorectal cancer or polyps.
• A personal history of inflammatory bowel disease (ulcerative colitis or Crohn’s disease)
• A confirmed or suspected hereditary colorectal cancer syndrome, such as familial adenomatous polyposis (FAP) or Lynch syndrome (hereditary non-polyposis colon cancer or HNPCC)
• A personal history of getting radiation to the abdomen (belly) or pelvic area to treat a prior cancer.

Average risk patients can use any of the recommended colorectal tests.

What are screening recommendations if you are increased or high risk?:

People at increased or high risk of colorectal cancer might need to start colorectal cancer screening before age 45, be screened more often, and/or get specific tests. This includes people with:

• A strong family history of colorectal cancer or certain types of polyps
• A personal history of colorectal cancer or certain types of polyps
• A personal history of inflammatory bowel disease (ulcerative colitis or Crohn’s disease)
• A known family history of a hereditary colorectal cancer syndrome, such as familial adenomatous polyposis (FAP) or Lynch syndrome (also known as hereditary non-polyposis colon cancer or HNPCC)
• A personal history of radiation to the abdomen (belly) or pelvic area to treat a prior cancer

Increased or high-risk patients are strongly advised to use colonoscopy for their screening.

What are the tools available for colorectal cancer screening?

Endoscopy-based test:

1. Colonoscopy (the whole colon + rectum) every 10 years if negative
2. Sigmoidoscopy (30-40 inches into colon) every five years if negative

Stool-based test:

1. FIT/FOAG stool Test every year if negative.
2. DNA/FIT stool test – Cologuard every three years if negative

Blood-based test:

1. Shield test – mainly tests for colorectal cancer

Radiology-based test:

1. Virtual (CT) colonography every five years
2. Barium enema every five years

The capsule colonoscopy is only for patients with incomplete colonoscopy.

Colonoscopy is recognized as the gold standard. However, getting any of the above tests is better than no test at all. Remember our goal is getting 80% of our community to start screening by the age of 45.

Why do I prefer colonoscopy over the other test?

Colonoscopy is the only procedure that can prevent colon cancer. You would not want to wait to have colorectal cancer before detecting it. If any of the other screening tests are positive, colonoscopy will need to be performed.

What are some recommendations for screening?

1. If you have history of colon polyps or colon cancer, or if you have symptoms, don’t get a Cologuard or shield (blood) test.
2. Get your follow-up screening test when it is time.

Remember, colorectal cancer is preventable and can be detected early enough to save your life. Don’t be afraid to get screened, which could cause you to wait and develop colorectal cancer. Be proactive!

 

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Gastroenterologist Dr. Kwadwo Agyei-Gyamfi is affiliated in private practice with Acme Medical Specialties in Lumberton and is a member of the UNC Health Southeastern Medical Staff.