March is colorectal cancer awareness month, so let us discuss colorectal screening! Based on guidelines and CDC recommendations: The latest USPSTF recommendation updates the 2016 guidance on colorectal cancer screening. It still advises screening for adults aged 50 to 75 but now suggests starting screening at age 45. Screening remains an individual decision for individuals aged 76 to 85, as it should be discontinued after age 85. Which test should we use? Stool Tests:
- Guaiac-based fecal occult blood test (gFOBT): This test checks for blood in stool samples once a year using a kit.
- Fecal immunochemical test (FIT): Also done annually, using antibodies to detect blood in stool samples.
- FIT-DNA test: This test combines FIT with a DNA test every three years by collecting and sending an entire bowel movement sample to a lab for analysis of altered DNA and blood presence.
Flexible Sigmoidoscopy:
- Procedure: A short, thin, flexible tube with a light is inserted into the rectum to check for polyps or cancer in the rectum and lower colon.
- Frequency: Every 5 years or every 10 years with an annual FIT.
Colonoscopy:
- Procedure: This procedure is similar to flexible sigmoidoscopy but examines the entire colon with a longer, thin, flexible tube to detect and remove polyps and some cancers.
- Frequency: It’s used every 10 years for those with average risk and for follow-up testing after abnormal findings in other screening tests.
However, if a family history is positive for colon cancer, guidelines are different:
- Familial adenomatous polyposis: Begin at age 10-12 years; flexible sigmoidoscopy or colonoscopy; repeat every 1-2 years until colectomy
- Lynch syndrome: Begins at age 20-25 years or 10 years earlier than the youngest cancer in the family; colonoscopy; repeat every 1-2 years
- Inflammatory bowel disease (Crohn’s disease or ulcerative colitis): Begin after 8 years of chronic colitis; colonoscopy with biopsies; repeat every 1-2 years.
How can we support our patients when we refer them for colonoscopy? Sutter offers a Colonoscopy Care Companion to provide information and support for this crucial screening. This resource guides patients through the process, from preparation to post-procedure care. Once the patient is scheduled for the procedure, it will be available on MyHealth Online! Patients will receive task reminders, dietary guidance, and information on what to expect during and after the colonoscopy! However, here are some tips to share with patients:
- To ensure effective colon cleansing, consuming the entire bowel preparation solution in two separate doses is essential.
- Adding citrus-flavored drink packets, chilling the prep, using a straw, or consuming lemon or lime wedges can improve the taste.
- Being at home during the prep is crucial as bowel movements start quickly.
- The day before a colonoscopy, it’s recommended to stay hydrated and follow a liquid diet—simply saying you can have it if you can see through it!