Screening for colon cancer (or colorectal cancer, bowel cancer)

[chassis]

This is a discussion on current recommendations, globally, and experience of posters on the site as it relates to screening for colon cancer. In other countries, this can be referred to as colorectal cancer or bowel cancer. I suggest including benchmarks from other countries with similar HDI as the U.S. I prefer the UK, Germany and Japan; many other good examples exist.

Screening guidelines in the U.S. seem to be changing: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7011914/

Note the change in screening guidelines from 2017 (Table 1) to 2019 (Table 2).

The UK NHS has a somewhat similar screening guideline as the U.S.: https://www.nhs.uk/conditions/bowel-cancer-screening/

In the UK, "Bowel scope" screening has recently been permanently stopped as standard protocol, in place of FIT testing.

What are people's experience and views on colon cancer screening? It would be great to have a clinician chime in on changes, if any, that have occurred in the U.S. for colon cancer screening recommendations.

 

[HenryD]

I got pitched the colonoscopy pretty hard on turning 50. After my annual check-up that year they tried to just schedule it for me before I even left. I'm low risk, so deferred to an annual FIT test up until this year. DW and I get HSA $ for screening and FIT meets the criteria.

We are a couple of years from losing DWs HI, and DW is relatively higher risk genetically, so we both agreed to colonoscopies this year (at 49 and 52). Both done at no cost to us, with no complications, and clean as a whistle. I was told after the procedure that I had the first clear one of the day, which is worth pondering.

DW will probably get retested at 10 years, I'll probably stick to FIT from here on. Our diets are protective, and we now both have a baseline. My concern about relying on the FIT exclusively would be the presence of polyps that are slow growing but not yet bleeding. Not sure of the validity of that concern, but take comfort in the colonoscopy results.

 

[f35phixer]

DW's mom was doing all the right things , if i remember checked ever 3 years or so. All was good until last check, had tumor close to rectum, had to remove it and lived rest of life with a ileostomy bag !!!!!!!!!!! I think its worth the little bit of discomfort to have them done...

 

[OldShooter]

WADR, this class of questions seeking medical advice from SGOTI always amazes me. My favorite internet carton: https://en.wikipedia.org/wiki/On_the_Internet,_nobody_knows_you%27re_a_dog#/media/File:Internet_dog.jpg

If you don't trust your doctor to discuss and answer the question IMO you need a new doctor. This is not to abdicate to the doctor but it is to recognize his/her education, experience, and expertise. It's almost certainly more than an individual can gain from reading a few web sites.

The other problem with almost all of the web site articles is that they are necessarily statistical in nature, where each of us is a sample of one. Statistical numbers do not predict anything about individual samples. In fact statistics assumes samples are random. To my doctor I am neither a statistic nor am I random. So SGOTI's opinions are not of great interest to me, although YMMV of course.

 

[pacergal]

Had my first colonoscopy at age 50, second age 60 due to family history of polyps, luckily non cancerous. DH has had every 5-7 years due to his mom having bowel cancer.
I follow our MDs recommendations, either FIT yearly or colonoscopy every 10 years, as long as negative findings.
In my nursing journals, I am reading more about bowel cancer occurring in younger ages, a concerning new finding.

 

[ER Eddie]

My experience with colonoscopy was bad, so I'm going the stool-sample route now.

Briefly, what happened to me: colonoscopy revealed a benign fat mass too large to "snip," and I was recommended for surgery. I was assured it was a minor surgery, nothing to worry about. Result: I nearly died, spent a horrible month in ICU then another month recovering, and the next year with a colostomy, which made me feel like a freak, then PTSD-level anxiety about the reversal surgery a year later. Absolutely miserable experience, the worst of my life. I don't blame the colonoscopy per se for the outcome -- it was the surgery that followed -- but the colonoscopy was the first step in the sequence, and I now have a very strong aversion to it.

I researched the colonoscopy, and as far as I can tell, there are a lot of questions about it. I won't feed all that information here, because it will just cause people to post counterclaims and concerns. But I'll just say that I have reservations about its benefits. Yes, I know some people do have cancer detected early, and that information ends up helping them. I'm glad. But for me, no thanks.

Fortunately, the stool sample test seems to be a good alternative and is less intrusive. I thought it was only good for 1 year, but my doc said it's for 2 or 3.

 

[sengsational]

I was put on the every-other year plan. My GI doc sent the recall letter and I sent back that I was going to go back and forth, one FIT (fecal immunochemical test) and then one traditional (eyeballing it). But I came across this, which says:

Previously published, peer-reviewed medical studies suggest that this tool increases precancerous polyp (adenoma) detection rates by 14%, potentially leading to a 42% reduction in colorectal cancers.

Of course they quote relative risk, and absolute would be much less impressive. But I was thinking that it might be interesting to go to Ohio. Last time I was in Ohio, I went to Cedar Point (with the kids).

https://trialsitenews.com/new-compu...-colon-cancer-based-at-ohio-state-university/

 

[Montecfo]

Screening colonoscopies are free in US (If you have ACA compliant insurance and meet age thresholds.)They remain the gold standard. I've had two, both clean, easy and no charge to me (though nothing truly free of course).

FIT tests make sense for folks at lower risk, IMHO.

 

[Ian S]

My very first colonoscopy at age 50 revealed either one or two polyps which put me on a five year repeat schedule. Next time there were three which put me on a three year schedule. This has been repeated until the last one when I was back to one polyp and a return to five year schedule. I will continue to have the colonoscopies as I don't think the FIT is recommended for someone with my history. Also my brother has a history of polyps and a cousin died of CRC. It was a miserable way to go and needless since he should have had a colonoscopy when he turned fifty. Apparently he didn't and it was only caught at a late stage.

 

[sengsational]

They are "free" (covered 100% by insurance), if you have zero history of any kind of previous disease process. Even family history can turn a preventive screening into a diagnostic test, and diagnostic test are NOT "free" (covered 100% by insurance). It used to be, they took you in under the "screening" and if they found a polyp, then they swapped it to be diagnostic, so you went from $0 to at least $1500 in the blink of an eye. I believe they've put an end to that shenanigans, but any noob should ask and get a clear understanding.

Prices vary tremendously, too. Hospitals can charge like $5000, all-in. You've got a lot of hands in the pot (physician, facility, pathology, anesthesia). They all often bill separately. Don't let the billing person at the doctor's office shrug off the questions. They know exactly what their contractors charge...they just won't tell you unless you press them. Even then, they might make you call the contractors directly.

 

[harllee]

DH's doctor pushed him to get his first colonoscopy at age 50. They found a large precancerous polyp and removed it. The doctor told him that in a year that polyp would have been cancer. DH was so glad he got the colonoscopy at age 50. Since then he has gotten one every 3-5 years as recommended by the doctor and they usually find a polyp and remove it. Colonoscopy is still the best way--if they find a polyp they remove it as part of the colonoscopy procedure.

 

[Speculator]

I received my first screening at age 52. Everything turned out fine and I had my second at 62 (fine, again) and will have my next one at 72. I did not enjoy the prep stuff but the exams were no problems. My brother, however, taking the advice of several friends (none of whom were doctors), decided against the screening and developed colon cancer at 62 and died of tracheal cancer just before his 65th birthday. Even though the doctors told him the colon cancer went into remission after treatment, I can't but wonder if the two cancers were somehow connected and if he had a colonoscopy when he should have at around age 50, he would still be alive.

 

[Teacher Terry]

I had a colonoscopy at 54 and didn’t have any polyps. My siblings that are 6 and 9 years older than me have had polyps so get them more often. I will have one more and then that’s it. I am 67 soon and your colon lining thins as you age which makes the risk higher of it being torn during the procedure.

 

[harllee]

I had a colonoscopy at 54 and didn’t have any polyps. My siblings that are 6 and 9 years older than me have had polyps so get them more often. I will have one more and then that’s it. I am 67 soon and your colon lining thins as you age which makes the risk higher of it being torn during the procedure.

That is correct. I had colonoscopies at ages 50, 60 and recently at age 70, no polyps. The doctor told me I did not have to have another colonoscopy unless I develop "problems."

 

[RetMD21]

Here are the 2021 USPSTF recommendations. There are several screening methods. Colonoscopy isn't preferred.

https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/colorectal-cancer-screening

Colonoscopy has quality issues.

 

[Montecfo]

Here are the 2021 USPSTF recommendations. There are several screening methods. Colonoscopy isn't preferred.

https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/colorectal-cancer-screening

Colonoscopy has quality issues.

Actually I did not see them recommending any particular screening methods. Did I miss something?

 

[chassis]

Actually I did not see them recommending any particular screening methods. Did I miss something?

Read the sections "Starting and Stopping Ages" and "Screening Intervals".

 

[RetiredAt55.5]

I've found that I get false positives from the stool tests, so that test is useless to me.

Stupid hemorrhoids.

 

[Montecfo]

Read the sections "Starting and Stopping Ages" and "Screening Intervals".

I did.

They are recommending screening intervals and offering characteristics of screening methods and pros and cons.

 

[RetiredHappy]

We have never had colonoscopies due to too many perforations encountered by friends and family. We used to do yearly FIT but ever since Cologuard has been approved, we have Cologuard tests every 3 years.

 

[KarenC]

I had my first colonoscopy when I was 55; the procedure went well, and everything was clean. Three years later I was diagnosed with stage III colon cancer. (Thankfully, that's currently in remission.) You never know.

 

[harllee]

I had my first colonoscopy when I was 55; the procedure went well, and everything was clean. Three years later I was diagnosed with stage III colon cancer. (Thankfully, that's currently in remission.) You never know.

Wow, that's awful, so sorry. Did the colonoscopy just miss a cancer that was there? How was it finally detected? So glad you are in remission now.

 

[harllee]

Here are the 2021 USPSTF recommendations. There are several screening methods. Colonoscopy isn't preferred.

https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/colorectal-cancer-screening

Colonoscopy has quality issues.

I just read your link and the study recommends a colonoscopy every 10 years. What is the quality issues with a colonoscopy? My doctor says colonoscopies are the best way to prevent colon cancer.

 

[MRG]

First at 50, they found polyps so I'm on the 5 year plan until 5 years ago they found eosinophils causing some issues, now I'm on a three year plan.

My older sister didn't want to get tested, too yucky. Her colon cancer treatment was worse.

 

[RAE]

Fortunately, the stool sample test seems to be a good alternative and is less intrusive. I thought it was only good for 1 year, but my doc said it's for 2 or 3.

Yeah, the Cologuard screening test is good for 3 years, I believe. Non-invasive, you just send a stool sample in for analysis. I had one done a couple years ago, and will have it done again next year. They look for certain DNA markers of cancer in the stool. It's supposed to be pretty accurate, and most insurers will cover it.