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Screening Tests for Adults (50 and Up)

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Not everyone in this age group may need screening for every condition listed here. Click on the links above to read more about each condition and to determine if screening may be appropriate for you or your family member. You should discuss screening options with your health care practitioner.

Colorectal Cancer

Colorectal cancer (cancer of the colon and/or rectum) is the third most common non-skin cancer in adults and the second leading cause of cancer deaths in men and women in the United States. Colorectal cancer is both preventable and treatable if detected early. Studies show that regular screening could prevent one-third of colorectal cancer deaths in the U.S. The five-year survival rate is 90% if detected early.

Screening tests that look for and remove polyps and lesions in the colon can prevent colorectal cancer. Because these are found most often in people 50 years of age and older, experts recommend universal screening of average risk people in this age group. However, if you have one or more risk factors for colon cancer as described below, you should talk to your healthcare provider about more rigorous or more frequent screening options.

Risk

The exact causes of colon and rectal cancer are not known, but greater risk of occurrence appears to be associated with genetic, dietary, and lifestyle factors. According to the Centers for Disease Control and Prevention (CDC), factors that may contribute to increased risk for colon cancer include lack of regular physical activity, low fruit and vegetable intake, a low-fiber and high-fat diet, obesity, excessive alcohol consumption, and smoking. African Americans have the highest incidence of colorectal cancer and Ashkenazi Jews have the highest risk of developing colorectal cancer.

More frequent screening is appropriate if you have risk factors. If you began screening before age 50 due to one or more of these risk factors, it is important that you continue screening at the interval recommended by your healthcare provider.

  • Average risk: This includes people over 50 with no other known risk factors.
  • Increased risk:
    • A family history of colorectal cancer or adenomatous polyps, a specific type of polyp associated with higher risk of colorectal cancer, increases your risk for colorectal cancer. Most of these cancers occur in people without a family history of colorectal cancer. However, as many as 1 in 5 people who develop colorectal cancer have other family members who have been affected by this disease.

      Specifically, if you have any first-degree relatives (parents, siblings or children) who had colorectal cancer or adenomatous polyps before age 60, or two or more first-degree relatives who had either finding at any age, you are in this risk category. The risk is about doubled in those with one affected first-degree relative. It is even higher if the first-degree relative was diagnosed at a young age or if multiple first-degree relatives were affected.

    • You may also be at increased risk for colorectal cancer if you have been diagnosed with colon cancer in the past or if you have had a history of polyps on a prior colonoscopy.
  • High risk: You are at high risk for colorectal cancer if you have inflammatory bowel disease, including chronic ulcerative colitis or Crohns disease. If you have a genetic syndrome such as familial adenomatous polyposis (FAP) or hereditary non-polyposis colorectal cancer (HNPCC) or if you are at an increased risk of HNPCC based on your family history, you are also in the high-risk category.

Screening Tests and Recommendations: Ages 50 to 75   | Over age 75

Several health organizations, including the American Cancer Society (ACS), U.S. Multi-Society Task Force on Colorectal Cancer, the American College of Radiology, U.S. Preventive Services Task Force (USPSTF), and the American College of Gastroenterology (ACG), have colon cancer screening recommendations. While there are minor differences, they each emphasize and support screening for colon cancer.

Recommendations for average-risk individuals include laboratory tests performed on stool samples that mainly detect existing cancers and imaging tests that examine the inside of the colon to detect pre-cancerous polyps as well as existing cancers. Your healthcare provider can help you assess your individual risk factors and which test(s) to use. No single test is preferred for all individuals. As the CDC notes, any of the recommended tests is better than no test.

The following tables summarize screening options for individuals with average risk for colon cancer:

Imaging Tests

These tests visualize the colon and can detect both pre-cancerous polyps and existing cancers.

Test Description Recommended Screening Interval Starting at Age 50 for People at Average Risk Pros Cons
Sigmoidoscopy Examination of the rectum and lower colon with a rigid or flexible lighted instrument Every 5 years Minimal preparation ahead of time; does not usually need sedation; fairly quick and safe Only examines about 30% of colon; can't remove all polyps; small risk of bleeding, infection or bowel tear; may need to have colonoscopy if abnormal result found
Colonoscopy Examination of the rectum and entire colon with a lighted instrument Every 10 years Can examine the entire colon; can remove polyps and take biopsies for pathological testing Extensive full bowel preparation ahead of time; sedation needed to perform; takes at least one day for prep and recovery; risk of bleeding, infection or bowel tears
Double contrast barium enema Series of x-rays of the colon and rectum; patient is given an enema with a white, chalky solution that outlines the colon and rectum on the X-rays; tube inserted in rectum, bowel is inflated with air Every 5 years Does not require sedation; can view entire colon; relatively safe; minimal risk of tear to colon Same full bowel preparation needed as for colonoscopy; cannot remove polyps; may need to have colonoscopy if suspicious results found
Virtual colonoscopy (CTC, or Computed Tomographic Colonography) Examination of the rectum and entire colon to the small intestine using X-rays and computers; tube inserted in rectum and bowel is inflated with air Every 5 years No sedation required; can view entire colon; relatively safe; minimal risk of tear to colon Full bowel preparation required; cannot remove polyps; may need colonoscopy if abnormal results; effectiveness as a screening tool is not fully accepted

Laboratory Tests

These tests are performed on stool samples and detect mainly existing cancers.

Stool Tests Description Recommended Screening Interval Starting at Age 50 for People at Average Risk Pros Cons
Guaiac-based fecal occult blood test (gFOBT) Test to detect hidden blood in stool sample Annually No bowel preparation; no direct risk to bowel; sample can be collected at home Dietary restriction before testing; cannot detect precancerous changes; detects any blood in colon, not just from cancers but from food or dental procedures
Fecal Immuno-chemical test (FIT or iFOBT) Test to detect hidden blood in stool sample; different collection technique than gFOBT Annually No dietary or drug restrictions; no bowel preparation; no direct risk to bowel; sample can be collected at home Cannot detect precancerous changes; may miss some cancers; one time testing not effective
DNA test Detects mutations in specific genes associated with colon cancer in DNA isolated from a stool sample Every three years, according to the American Cancer Society No bowel preparation or dietary restrictions; sample can be collected at home; no risk of bowel tear Cannot detect precancerous changes; adequate stool sample must be obtained; special handling needed

Guidelines urge the use of a screening test such as colonoscopy or sigmoidoscopy that is good at finding pre-cancerous polyps because these procedures can help prevent cancer rather than only detect it after it has developed. These procedures are considered invasive yet are recommended and should be discussed with your healthcare provider. Stool sample testing and sigmoidoscopy are easier than colonoscopy but not as accurate. They are best used in conjunction with each other.

Other recommendations:

  • People whose first-degree relatives had colorectal adenomas or cancer at 60 years or older can be screened as those with average risk; those whose first-degree relative was diagnosed before the age of 60 may wish to consider screening at an earlier age than 50 years.
  • If you have increased or high risk for colorectal cancer due to a personal history of polyps or colon cancer, family history, hereditary syndromes such as hereditary non-polyposis colorectal cancer (HNPCC), you should talk to your healthcare provider about more aggressive and frequent screening.
  • A colonoscopy is usually recommended for people who are at increased or high risk of colon cancer because it is the most accurate and thorough. Also, the recommended screening interval for high-risk individuals is shorter than for people with average risk, such as every 1-2 years or every 5 years compared to every 10 years.
  • Both men and women of African descent should begin testing at age 45.
  • While the incidence of colorectal cancer is greater in men, women are cautioned to not delay screening and should also begin at age 50.
  • Those who are heavy cigarette smokers or who are obese may also be candidates for early screening procedures and some suggest the age of 45 years.

Recommendations: Over age 75 | Ages 50 to 75 

The U.S. Preventive Services Task Force (USPSTF) revised its guidelines in October 2008 to recommend against routine screening in people aged 76 to 85 who have had consistently negative screening results since they were age 50 and against screening for anyone over the age of 85 years.

Decision Aids

Because any invasive procedure carries some level of risk, you should talk to your healthcare provider about the screening tests recommended for you. Some employers, health plans, and health practitioners offer decision aids.

Also, don't neglect the protection of getting re-tested at the interval recommended by your healthcare provider.


Links
MyBiopsy.org: Colon, Adenomatous polyps 
National Cancer Institute: Colorectal Cancer Risk Assessment Tool 
Centers for Disease Control and Prevention: Colorectal (Colon) Cancer


Sources Used in Current Review

Colon Cancer Alliance. Guaiac Fecal Occult Blood Test (FOBT). Available online at http://www.ccalliance.org/screening/fecal-occult-blood-test.html through http://www.ccalliance.org/index.html. Accessed February 2015.

Colorectal Cancer Screening Guidelines. Centers for Disease Control and Prevention. Available online at http://www.cdc.gov/cancer/colorectal/basic_info/screening/guidelines.htm through http://www.cdc.gov. Accessed February 2015.

(October 15, 2014) American Cancer Society. Colorectal cancer screening tests. Available online through http://www.cancer.org. Accessed February 2015.

Final Recommendation Statement: Colorectal Cancer Screening. U.S. Preventive Services Task Force. Available online at http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/colorectal-cancer-screening through http://www.uspreventiveservicestaskforce.org. Accessed February 2015.

(Published online 2008 February 13) Screening and Surveillance for the Early Detection of Colorectal Cancer and Adenomatous Polyps, 2008: A Joint Guideline From the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. American Gastroenterology Association [On-line information]. Available online at http://www.gastrojournal.org/article/S0016-5085%2808%2900232-1/fulltext through http://www.gastro.org/practice/medical-position-statements. Accessed February 2015.