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Detecting and Preventing Colon Cancer
Detecting and Preventing Colon Cancer
by Jonathan S. Feinberg
Gastroenterologists work closely with primary care physicians as the first line of defense against colon cancer. “Our role involves using direct visualization of the colon to detect precancerous colon polyps and colon cancer,” says Karen L. Woods, MD. Gastroenterologists carry out this frontline role primarily through colonoscopy.
“Colonoscopy is not only a detection test, but a colon cancer prevention test,” Dr. Woods explains, “because we find polyps while they are small, before they become cancer. We can remove them and prevent cancer from developing.” If colonoscopy reveals large polyps or cancer, patients may be referred for specialized endoscopic resection or surgery.
Although colonoscopy is the gold standard for detecting and removing polyps and even early-stage cancer from the colon, the FDA has also approved the Fecal Immunochemical Test (FIT) and Cologuard® tests for colon cancer screening. FIT is a stool-based test that detects human blood in the stool; Cologuard® combines FIT with a test for DNA shed from tumor cells. These tests can be prescribed by primary care physicians, so they are readily accessible to patients without a referral and may be good options for those who prefer to avoid colonoscopy. Patients who test positive on FIT or Cologuard® are referred to GI specialists for colonoscopy and further care.
Karen L. Woods, MD
Rachel L. Schiesser, MD
Dr. Woods cautions, however, that although FIT and Cologuard® can effectively detect colon cancer, they are less reliable for detecting polyps. As a result, these tests must be performed more frequently than colonoscopy (annually for FIT, every three years for Cologuard®) to ensure that they catch cancer early. Nonetheless, Dr. Woods stresses, “Any test is the best test as long as you do it, you get it done correctly, and you get the proper follow-up thereafter.”
Changes in the available tests have been accompanied by changes in the recommendations for colon cancer screening. In 2021, the US Preventive Services Task Force lowered the recommended age for screening from 50 to 45 in adults with average risk (no family history) of colon cancer. Rachel L. Schiesser, MD, explains that the guidelines were changed in response to an increased risk of colon cancer in younger generations: 45-year-old adults now have the same risk of colon cancer that 50-year-olds had in previous generations. Although the cause of this increased risk remains under investigation, Dr. Schiesser says that environmental factors, such as dietary changes in recent decades, appear to be involved.
Despite these changes in risk, early detection remains the key to prevention and effective treatment. As Dr. Woods says, “Just get screened.”