Keeping Your Colorectal Cancer Screening Options Open

New guidelines offer a variety of screening tests for colorectal cancer, some of them noninvasive.
AFTER AMANDA HOUSTON WAS diagnosed with colon cancer at the age of 34 in 2013, her mother made an appointment for her first colonoscopy at age 60 — a full 10 years after oncologists generally recommend that patients start regular screening for colorectal cancer. Houston’s mother turned out to also have the disease, but her cancer was in a far more advanced stage, requiring surgery and 12 rounds of chemotherapy. Houston, a human resources professional in Fargo, North Dakota, was treated successfully with surgery alone.

Both mother and daughter are now clear of the disease, but the difficult experience has turned Houston into a proponent of regular screening for colorectal cancer. “I really don’t know why my mother put it off,” Houston says. “If she had been screened at 50, maybe her cancer would have been prevented or caught at a much earlier stage.”

Colorectal cancer screening is becoming easier and more accessible, thanks to updated federal guidelines implemented in the summer of 2016. The guidelines were issued by the United States Preventive Services Task Force (USPSTF), which makes health care recommendations that insurers consult when determining which procedures they will cover. The new guidelines, an update of 2008 recommendations, embrace a variety of screening tests beyond colonoscopy, some of which are noninvasive and easy to perform at home.

That’s important, because many resist colonoscopy due to its downsides, which include the need to fast and clear out your digestive system beforehand, and to be put under with sedation or general anesthesia for the test itself. About a third of eligible adults have never been screened for colon cancer, according to data collected by the USPSTF, and the agency estimates that 134,000 people were diagnosed with the disease in 2016 and 49,000 lost their lives to it. Yet several studies have demonstrated that colonoscopy and the other colon cancer screening tests have reduced the number of deaths attributable to the disease. The tests are important for everyone eligible, regardless of prior cancer status.

“I don’t care which test you get, I just want you to be screened,” advises John Marshall, M.D., director of the Ruesch Center for the Cure of Gastrointestinal Cancers at Georgetown University. The new guidelines, he adds, “should further close the gap and increase the participation of people” who are eligible for colorectal screening but have not yet opted for it.

The revised USPSTF guidelines award “A” grades to six colorectal screening tests and one combination of two of the methods for people between the ages of 50 and 75. Three of the strategies are at-home stool-based tests. Two of those tests, guaiac-based fecal occult blood test (gFOBT) and fecal immunochemical test (FIT), are designed to find blood in the stool, which can be an early sign of precancerous polyps or cancer. Patients who test positive would then be sent for colonoscopies to finalize the diagnosis.

Talk about this article with other patients, caregivers, and advocates in the Colorectal Cancer CURE discussion group.
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