Colorectal cancer screening: Why you need it, what it’s like and how care has changed  

It’s not an experience that most people look forward to, yet a colonoscopy may just save your life. According to the American Cancer Society, colorectal cancer is the second-leading cause of cancer-related deaths in U.S. adults.

Screenings, such as colonoscopies, can detect and address colorectal cancer early, when it’s easily treatable. For many years, the recommendation was to start colorectal cancer screenings at the age of 50, but in spring 2021 the U.S. Preventive Services Task Force (USPSTF) updated its guidance.

“Thanks to the success of screening, there’s been a decline in colorectal cancer for those 50 and older,” says Dan Lawson, MD, a gastroenterologist and interventional endoscopist at MultiCare Rockwood Clinic. “However, the incidence of colorectal cancer has been rising in younger age groups since the 1990s. That’s why the USPSTF now recommends that most people should start getting screened at 45, instead of 50.”

The screening timeline for colorectal cancer isn’t the only thing that’s changed in recent years. There have been advances in every aspect of colorectal cancer care, from new screening options to improved surgical treatments.

What happens during a colonoscopy?

So, why all the fuss about colorectal cancer screening in the first place?

“It’s one of the most therapeutic screenings you can get,” says Laila Rashidi, MD, FACS, FASCRS, a colorectal cancer surgeon at MultiCare. “Through screening, we can find these small abnormal growths called polyps and remove them before they have the opportunity to develop into cancer.”

The gold standard when it comes to colorectal cancer screening is the colonoscopy: a procedure where a gastroenterologist or surgeon inserts a thin flexible tube (or scope) with a camera into the rectum to investigate the lining of the colon. If polyps are found, they are removed and may be sent to a lab for testing.

“Many people worry about pain or discomfort during this low-risk procedure,” says Dr. Lawson. “However, the scopes we use are very small, plus a person is typically sedated for a colonoscopy, so they aren’t even aware that it’s taking place. In nearly all cases, the procedure is pain-free both during and afterward.”

The physician performing your colonoscopy can walk you through the different types of sedation available. Most are short-acting. While you won’t be able to drive yourself home afterward, recovery is minimal and grogginess does not linger.

Another aspect of the colonoscopy process that many people dread is the preparation. In addition to dietary restrictions, this process involves taking a medication starting the night before the procedure that cleanses the bowels.

“It used to be that patients had to drink large quantities of a liquid that didn’t taste so good and could cause some nausea,” says Dr. Rashidi. “But there are more, better-tasting options for patients to choose from now — some that are low-volume or even come in tablet form.”

Beyond colonoscopies: Other options

While a colonoscopy is the gold standard, it isn’t the only option when it comes to screening for colorectal cancer. Some people may feel a colonoscopy is too invasive or they may not want to take time off from work to do the procedure.

Other options include home testing kits, where you take a stool (poop) sample and mail it to a lab for analysis, but if it comes back positive, you’ll need to schedule a colonoscopy. Home test kits may or may not be covered by your insurance, so it’s a good idea to check before purchasing one.

Another screening option is flexible sigmoidoscopy. It’s similar to a colonoscopy except it only examines the lower part of the colon and does not require sedation, so a person is able to drive themselves home afterward.

Talk to your doctor about what screening options might be best for you. People with no risk factors only need to undergo a colonoscopy every 10 years. If you have a family history of colorectal cancer or other risk factors, then you may need to undergo more frequent screening. Screening methods other than colonoscopies, such as home-based stool tests, typically need to be completed more often than every 10 years.

What if you are experiencing symptoms?

Colonoscopies are part of routine cancer screening; however, they are also a useful diagnostic tool if you have symptoms of colorectal cancer.

“One of the most common symptoms I see in my practice, particularly among younger people, is blood in the stool,” says Dr. Rashidi. “People often dismiss it as hemorrhoids at first, only to find out a few months later that it’s cancer. If you are frequently seeing blood in your stool, then talk to your primary care doctor or make an appointment with a gastroenterologist.”

Other common symptoms of colorectal cancer include changes in bowel habits, such as frequent diarrhea or constipation, persistent abdominal pain and unintentional weight loss.

Treatment advances for colorectal cancer

If a colonoscopy or another screening method reveals more than a small precancerous polyp, then you may be wondering what happens next.

Treatment for colorectal cancer depends on a variety of factors, including the location of the cancer, its type, how advanced it is as well as the overall status of your health. One common approach to treatment is surgery, which, like colorectal cancer screening, has come a long way.

“We do far fewer big open surgeries for colorectal cancer these days,” says Dr. Rashidi. “Instead, we often rely on minimally invasive techniques such as robotic surgery. These approaches allow us to be very precise. Patients tend to have great outcomes, fewer complications, smaller incisions and faster recoveries. The average length of a person’s hospital stay after colorectal surgery now is one to three days, but some select patients can even be discharged the same day.”

If you have been putting off colorectal cancer screening or are experiencing symptoms of colorectal cancer, now is the time to reach out to your doctor.

The Affordable Care Act (ACA) requires insurance companies to cover the costs of colorectal cancer screenings, but the law doesn’t apply to health plans in place before the ACA was passed in 2010. It’s a good idea to verify coverage for colorectal cancer screenings with your insurance company first, particularly if you are under the age of 50.

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