This post is the first of a series of articles on prevention. I prefer to follow the US Preventive Services guidelines, which are authoritative and evidence based.
Adults should be screened for colorectal cancer beginning at age 50 and continuing until age 75 years. This should be done using either fecal occult blood testing, sigmoidoscopy, or colonoscopy. Sigmoidoscopy or colonoscopy should be performed every 10 years. Fecal occult blood testing should be done annually. Persons who have a higher risk for colon cancer, or who have had an abnormal prior colonoscopy should have follow up procedures sooner than 10 years (usually between 3 and 5 years).
Fecal occult blood testing has been shown to be equivalent to colonoscopy for screening in normal risk patients. There are two types of tests, guaiac-based tests and fecal immunochemical tests (FIT). Because the FIT test is more sensitive, I recommend using this type of test over the stool guaiac test.
Because annual FIT testing is as effective as colonoscopy or sigmoidoscopy, and because it does not require elaborate and uncomfortable preparation, I prefer this approach to colorectal cancer screening in patients who are low or normal risk for colon cancer.
Risk factors for colon cancer include a history of colon polyps, presence of blood in the stool, a change in bowel habits, presence of anemia, history of unexplained abdominal pain, or a history of unexplained weight loss. Additional risk factors include obesity, physical inactivity, diets high in red meats, smoking, heavy alcohol use, a history of inflammatory bowel disease, a family history of colon cancer, or an inherited condition (such as Lynch Syndrome). In addition African American persons and those with type 2 diabetes are at increased risk.
If you have questions about these recommendation, or would like to discuss this or other health issues, call or come in to see me at Dr. Smith Direct Care.