Diagnosis
Colon and rectal cancers are diagnosed using the screening tests discussed below. These tests can detect precancerous polyps and colorectal cancers at stages early enough for complete removal and cure.
Unfortunately, only 30% to 40% of adults over 50 years old (mostly in the upper socioeconomic group) have regular screening tests that could detect a cancer early enough for curative treatment. A survey reported that many people are not screened because they are too embarrassed and revealed that they would rather lose months off their life than face these tests. Those who had already had the tests were willing to have them again if they saved one additional day of their lives. There is some debate about what is the best screening modality. However almost all experts agree that not enough people are screened and that if these tests were adopted with the same regularity as other screening tests, such as Pap smears, they would save many lives. It is especially important that anyone at increased risk or with symptoms, such as rectal bleeding, undergo testing.
General Screening Guidelines
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Individuals should discuss with their physician the risks and benefits of all screening procedures. Some controversy exists over how often people without risk factors for cancer should be screened and which detection method should be used for them.
Guidelines for Adults Age 50 and Over with Average Risk
The following are the most recent expert screening guideline options for people at age 50 and over who have no symptoms and no family history of colon cancer (or possibly also no family history of benign polyps):
- A fecal occult blood test (FOBT) every year and a flexible sigmoidoscopy every five years. A follow-up colonoscopy should be done if any questionable results are found in either test. (The FOBT should be conducted first, since sigmoidoscopy would be replaced by colonoscopy if findings were suspicious.)
- Many medical experts are now recommending a colonoscopy every 10 years, replacing sigmoidoscopy at that interval.
- Another alternative for viewing the entire colon is a barium enema every five years, although it is less clear if this screening test offers any survival advantages.
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