The Expert:
Dr. Fola May, MD, Ph.D, M.Phil
When should people start screening for colorectal cancer? How often should you get tested?
Screening for colorectal cancer actually depends on your risk level, so if you are a person who does not have a medical condition that predisposes you to colorectal cancer and you do not have anyone in your family who has had that condition, you will actually start screening at age 45. And according to the test, you will be screened every 10 years. If you choose a colonoscopy, uh, some of the least invasive tests you can do at home — stool kits — you should do them every one to three years. Now, if you have a family history of colorectal cancer — so if you have a mom, dad, brother, or sister who’s had it — we’re actually going to start screening you earlier. So we will start screening you at age 40, which is 10 years before the first family member is diagnosed. So, for example, if your father was diagnosed with colorectal cancer at age 35, we will start screening you at age 25.
What are the different screening methods?
One of the advantages of the technologies we have for cancer screening is that, for colorectal cancer in particular, there are many ways to get screened. So for some cancers there is only one option. For colorectal cancer, you can choose from several. We have a governing body in medicine called the United States Preventive Service Task Force, and they actually recommend one of seven different strategies. So as long as you choose one of these seven tests, we believe you are getting a high quality screening test. The most invasive strategy is colonoscopy. It is when we perform a medical procedure in a hospital or clinic. We clean the colon with the laxative so we can actually look at the lining of the colon for early signs of colorectal cancer, and the least invasive tests are stool-based tests. These are wonderful because you can make them at home, and all you need to do is drop a small stool sample into a Bio Safe container and send it off to a lab. So you can get screened by colonoscopy, you can use one of these stool-based tests, there’s also a CT scan that’s available for screening, uh, and a few other options as well.
What type of provider performs colorectal screening?
Generally, most people will get a recommendation to start their colorectal cancer screening from their primary care physician. Indeed, the primary care physician in medicine really organizes everything from preventative health to chronic disease management, so your PCP is the one who will get your family history of cancer from you, understand your other risk factors, and tell when to start screening. for colorectal cancer — whether at age 45 or younger. Now, if you choose colonoscopy as your screening method, then you will be referred to a gastroenterologist. I am a gastroenterologist. We perform screening colonoscopies in hospitals and clinics, sometimes with the help of an anesthetist to put you to sleep during the procedure.
How to find a supplier?
For people already connected to the healthcare system, it is quite easy to find a provider who can offer you colorectal cancer screening. You have just spoken to your primary care physician. He will either refer you to a gastroenterologist or order you a stool-based kit that you can make at home. Sometimes people will see their obstetrician-gynecologist or OB-gynecologist as their primary care provider, and these doctors may also recommend screening. Now, if you find yourself in a situation where you don’t have a healthcare facility that you consider your home base, you can check out other resources. So, you can research local clinics or hospitals to see if you can find a primary care provider through those networks.
I also know that Fight Colorectal Cancer or Fight CRC have a patient-provider portal on their website. If you google “Fight CRC patient-provider finder” this will also point you in the direction of a gastroenterologist who can perform your screening colonoscopy.
How do you think healthcare providers can help manage fear and/or anxiety related to colorectal cancer screening?
I think the most unfortunate thing about colorectal cancer screening is the lack of awareness and misinformation. Thus, colorectal cancer is the second most common cause of cancer-related death in the United States. Unfortunately, it’s very common in women and men, but it’s not necessary, because we think we can prevent about 90% of cases through screening, so it’s very important that people understand that It’s a common disease, it’s a deadly disease, but there’s something we can do about it. Unfortunately, in the media, there’s been, uh, a lot of jokes about colonoscopy being an uncomfortable procedure, particularly because it involves an instrument that’s placed in an intimate area. What I like to remind people, however, is that we are taking you to a safe hospital or clinic. We give you medication to put you to sleep during the procedure—sometimes completely asleep with the help of an anesthesiologist—so that you don’t feel the colonoscopy at all. You won’t feel pain, you won’t be uncomfortable during the procedure. In fact, most of my patients wake up and look at me and say, “Doctor, when are you going to start?” And I tell them that we have already completed the procedure. So really the hardest thing for some people is the day before the colonoscopy, when they have to do the laxative, which is the cleanser to cleanse the colon of all the food and all the stool in it, and it can be a bit difficult for people. You’re on a clear liquid diet, and you take this laxative, you’re on the bathroom a lot, but once you get through that day and come in for the procedure itself, it’s pretty easy from there. And then I’ll also mention for those stool-based tests, the ones that you can do in the comfort of your own home, so if you’re not so keen on going in and having a colonoscopy with a gastroenterologist, just remember that you still have other options. You can do these very simple stool tests once a year in the comfort of your own home.
What are the next steps if a colorectal cancer screening test is positive?
For most people, you’ll get a colorectal cancer screening test at age 45, and that screening test will be normal and you’ll be off the hook for a while. So if you get screened with a colonoscopy and it’s normal, you don’t have to do anything for 10 years. If you get tested with a stool-based kit and it’s normal, you don’t need to repeat this test for one or three years. So you get some protection for a while. Now, if the test is abnormal, we have to go a different route. If the colonoscopy is abnormal, we sometimes bring people back up to every three years, depending on the results. If the stool test is abnormal, these people actually need to have a colonoscopy to find out why the stool test is abnormal, and this is very important because these stool tests become a two-step process in which 7-10% of People who have an abnormal result will still need this colonoscopy to determine if there is a polyp or growth that is causing this stool test to be abnormal.
Anything else people should know about colorectal cancer or screening?
What I always like to point out to my friends and patients, and to the women in my family, is that colorectal cancer can affect women too. There’s this misunderstanding that colorectal cancer is a man’s disease, and it’s not true. Women, unfortunately, catch this disease or die from it, and it is useless in many cases, because we can prevent this disease through screening. So I would encourage all women, in addition to the screening they do for breast cancer, for cervical cancer, the skin exams you do for skin cancer, make sure also include colorectal cancer in the list of diseases you are trying to prevent.
Where can patients find more resources or information about colorectal cancer?
So I always recommend people talk to their primary care provider or trusted providers first, and there are plenty of information resources on the internet as well. I particularly like the resources provided by Fight Colorectal Cancer or Fight CRC. On their website, they have information on what colorectal cancer is, what screening is, the different screening methods. They also have resources on the different types of colorectal polyps. And if you’re in the situation where you or a family member is diagnosed with colorectal cancer, they have amazing resources for patients and families, so I always tell people to start there.
