How often have you stopped short of the finish line on your health goals? A new study published in JAMA Network Open found that 52 percent of patients did not follow through with colon cancer screening recommendations when hidden blood was found in their stool samples.

Two Types of Colorectal Cancer Screenings

Cancer of the colon and rectum is a leading cause of cancer death in the United States. There are two types of screenings that help detect colon cancer or abnormalities:

• Stool-based tests — These tests are less invasive and check for signs of cancer in a stool sample. You must repeat these tests more often than visual exams. Examples of these are fecal immunochemical tests (FIT) and stool DNA tests.
• Visual exams — These cancer screening tests look for abnormalities in the structure of the rectum and colon. Colonoscopy, flexible sigmoidoscopy and virtual colonoscopy are the three tests available.

Colonoscopy is the gold standard for colon cancer screening. During colonoscopy, your doctor will visually inspect the entire colon and remove pre-cancerous polyps, which reduces the risk of cancer. If you do not have polyps, you may not need to repeat the test for 10 years.

Young patients and patients who are at average risk for colon cancer sometimes prefer stool-based tests (SBT) because they do not have to do colonoscopy prep or take time off work. If the test is positive, patients need to schedule a colonoscopy to determine whether the blood is from colon cancer or another source, like hemorrhoids or ulcers.

Less Than Half of Adults Complete Necessary Follow-Up Colonoscopy

Elizabeth L. Ciemins, PhD, MPH, from the American Medical Group Association in Alexandria, Virginia, led a quality improvement study to analyze whether screening-eligible adults chose to get a follow-up colonoscopy after an abnormal stool test.

“Based on our previous work, we recognized a serious deficit in patients receiving the necessary follow-up after an abnormal stool-based screening test for colorectal cancer,” said Dr. Ciemins. “Our accompanying qualitative research identified a lack of awareness in current rates of follow-up by primary care providers and others.”

The researchers looked at data from 38 health care organizations for 20,581 patients aged 50 to 75 years who received abnormal results from a colorectal cancer SBT. The team found that 47.9 percent had a follow-up colonoscopy within six months.

The study found that follow-up colonoscopy screening rates were lower among Black patients (37.1 percent) and patients with Medicare and Medicaid (49.2 and 39.2 percent, respectively).

“Use of SBTs may increase overall screening rates, but abnormal results must be followed up with a colonoscopy to diagnose CRC — ideally as soon as possible, but definitely within the six months after an abnormal test result,” the research authors wrote.

Tips Make Colonoscopy More Manageable

Have you received a positive stool-based test and you need to schedule a follow-up colonoscopy?

A colonoscopy might seem scary or intimidating, but the new prep solutions are low-volume, more palatable and easier to consume. Here are seven tips to make a colonoscopy prep more comfortable:

1. Reduce or eliminate meat from your diet a few days before your prep day.
2. You will need to spend one day on a clear liquid diet. Create variety in your clear liquids by purchasing assorted flavors of broth, gelatin and Italian ice. Just remember to avoid anything that has red or blue dye, as it may make it more difficult to examine the colon.
3. Chill your colonoscopy prep liquid. Drink it chilled and chase it with cold water.
4. Use a straw to drink the prep liquid. You can drink it faster and you will not taste it as much.
5. Purchase soft toilet paper and flushable wipes.
6. Plan to watch that new series or movie on prep day, as it will give you something to look forward to instead of dread!
7. Plan an at-home project or activity that will occupy you on prep day.

Screenings Essential for Preventive Care

Preventive medical care is important for optimum health, but we often put health screenings at the bottom of our to-do list. Colon cancer is the second-leading cause of cancer death in the United States, but one-third of Americans are overdue for a colon cancer screening.

The American Cancer Society recommends that all adults who are at average risk for colon cancer begin screening at age 45. If you have a family or personal history of colon cancer, colon polyps, inflammatory bowel disease or hereditary colon cancer syndromes such as Lynch syndrome or FAAP, you should undergo screening at an earlier age.

Most insurance plans provide coverage for screening colonoscopy beginning at 45, but call your insurance provider for more details about your health plan. Now that we are in the second half of the year, it is important to schedule procedures as soon as possible.

Are You Looking for a GI Specialist?

Perhaps you have not scheduled a colonoscopy or GI consultation because you need to find a gastroenterologist. Our fellowship-trained gastroenterologists are accepting new patients at our GI facilities nationwide. Call our centers today to ask about colon cancer screening or any other digestive procedure. We offer treatment for GERD, diverticulitis, Crohn’s disease, ulcerative colitis and other chronic digestive system conditions.

Colorectal cancer is preventable with regular screenings, and it is easier to treat if doctors diagnose it at an early stage before the disease spreads.

Colon Cancer Is a Common but Generally Preventable Cancer

Did you know nearly 60 million people between 45 and 85 are eligible for colon cancer screening in the United States? According to a study published in JAMA Network Open, the screening-eligible population is 57.1 to 59.6 million people.

Colon cancer is the second-leading cause of cancer death among adults, but it can affect individuals of all ages. The American Cancer Society recommends that everyone who is at average risk for colon cancer begin regular screening at age 45.

What Are the Screening Options for Colon Cancer?

There are two main categories of colon cancer screening methods: tests that analyze stool samples and visual examinations. All tests have different risks and benefits.

• Stool-based tests — These tests are non-invasive and check for signs of cancer in a stool sample. You must repeat these tests more often. Examples of stool-based tests include the following:
  • Fecal immunochemical test (FIT) — You must repeat this test every year.
  • FIT/Stool DNA test — You must repeat this test every three years.
  • Guaiac-based fecal occult blood test (gFOBT) — You must repeat this test every year.
• Visual exams — These cancer screening tests look for abnormalities in the structure of the rectum and colon. Examples of visual exams include the following:
  • Colonoscopy — This is the gold standard for colon cancer screening because a doctor can remove polyps during the procedure and reduce the risk of cancer. If you do not have polyps, you may not need to repeat the test for 10 years.
  • CT colonography — Must be repeated every five years.
  • Sigmoidoscopy — Must be repeated every five years.

Even though colonoscopy is the most comprehensive colon cancer screening of the colon and rectum, stool-based tests have the benefit of being non-invasive and convenient. It is important to remember that if you get an abnormal result from a stool-based test, you must follow up with a colonoscopy (American Cancer Society). Follow-ups are recommended within six months following the abnormal test.

Deficits in Colon Cancer Screenings

Unfortunately, many Americans are not up to date on colorectal cancer screening. Reasons can range from avoidance to lack of education, but millions of people are not getting screened at recommended intervals or not getting tested at all.

“We hope our estimates can support policy makers and health care stakeholders to advance initiatives surrounding colorectal cancer screening to prevent this disease or identify it earlier when more can be done to treat it,” said Derek W. Ebner, MD, of the division of gastroenterology and hepatology at the Mayo Clinic.

Dr. Ebner conducted a study among people between the ages of 45 and 85 who were at average risk for colon cancer. In that sample, 59.3 percent to 61.8 percent were current on screening. The final estimated population that was eligible for screening was 57.1 to 59.6 million people, including individuals who were eligible for screening the following year.

Who Is at High Risk for Colorectal Cancer?

People qualify as increased or high risk if they have any of the following:

• A family history of colorectal cancer
• A personal history of colorectal cancer or specific type of polyp
• A personal history of inflammatory bowel disease (like ulcerative colitis or Crohn’s disease)
• A confirmed or suspected hereditary colon cancer syndrome, like familial adenomatous polyposis (FAP) or Lynch Syndrome (hereditary non-polyposis colon cancer)
• A history of radiation in the abdomen or pelvis because of prior cancer (ACS)

You May Be Due for a Colon Cancer Screening

If you are 45 or older, talk to your doctor about whether you are eligible for colon cancer screening this year. Most insurance plans provide coverage for screening colonoscopy for patients beginning at age 45, so call your insurance plan to verify coverage.

Locate a Colorectal Screening Center Near You

Our GI centers have fellowship-trained gastroenterologists to meet all your digestive system needs. Whether you seek a colon cancer screening or a consultation for a chronic GI problem, our physicians and caring staff are available to serve you. Call today to make an appointment.

Colon cancer survivor Karen Fisher transformed her pain of diagnosis into a purpose to help others.

The Inverness, Florida, pharmacist helps newly diagnosed colorectal cancer (CRC) patients find support resources and encourages adults to get timely preventive screenings.

“I have been able to help friends, coworkers and neighbors get screened for colon cancer,” Fisher said. “It makes me feel good to be able to help other people prevent going through what I went through.”

Fisher learned she had Stage 2A colon cancer at age 54.

“Colon cancer wasn’t really even on the radar,” she said. “So, it was kind of a shock.”

March is National Colorectal Cancer Awareness Month. This monthlong campaign promotes the research, prevention, diagnosis, treatment and, ultimately, cure for this disease.

The American Cancer Society (ACS) estimates about 106,590 people will be diagnosed with colon cancer and about 46,220 with rectal cancer in 2024.

Don’t Make Excuses for Not Getting Screened

In 2016, experts recommended that colorectal cancer screenings begin at 50 for people at average risk for the disease. Fisher turned 50 that year but made excuses to postpone her screening.

“I was busy with work and teenagers and after-school activities, and you know, moms take care of everybody else but themselves,” she said. “I had even driven my husband to his colonoscopy when he turned 50. He’s five months younger than me.”

The U.S. Preventive Services Task Force recommended the screening age be lowered to 45 in 2021 because of an increase in cancer in younger people. CRC is now the number one cause of cancer death in men and the second in women younger than 50.

Fisher had no family history of CRC and did not think she had any symptoms.

“I had blood in the stool, but at the time I was perimenopausal, and I thought I was spotting between periods,” she said. “Looking back, I can recognize that yes, I had a symptom.”

Fisher’s health insurance required her to get a colonoscopy at the hospital where she works.

“That was one thing that prevented me from getting screened in a timely manner. I didn’t want to get naked in front of my coworkers,” she said. “I knew everyone in the endoscopy department. I didn’t want them to see me, so I put it off.”

Colonoscopy Reveals Cancer Diagnosis

In May 2020, Fisher tried to donate blood but was turned away because her hemoglobin level was low. Blood tests revealed Fisher had iron deficiency anemia. To determine the cause, her family doctor ordered a colonoscopy.

Because of the COVID-19 pandemic, a backlog of cases at the hospital, and the urgent nature of her anemia, she was able to get a medical exception to have the procedure at Citrus Endoscopy and Surgery Center in nearby Crystal River.

Gastroenterologist Trupti Shinde, MD, performed the colonoscopy and found a 5 cm mass in Fisher’s colon. Dr. Shinde referred her to Parth Patel, MD, general surgeon, to remove the tumor and scheduled surgery in July 2020. Pathology revealed that the cancer was Stage 2A.

“It was just such a whirlwind of activity with me. You know, me still trying to work full time, too, and trying to process all of this in my head,” Fisher said.

A Foundation to Help CRC Patients

About six months post-surgery, Fisher scheduled a follow-up appointment with Dr. Shinde. The two discussed the lack of support and resources for colorectal cancer patients and caregivers.

“After recovery, I asked all my doctors about a support group for colon cancer but none of them knew of any,” Fisher said. “I did a lot of research online and found a lot of good resources. I wanted to share them with other colon cancer patients.”

Patient and doctor began offering support groups at the local library without much success. Undeterred, they refocused their efforts on compiling a list of patient resources into a pamphlet designed by Fisher’s son. Then they shared the pamphlets with local surgery centers and healthcare facilities for distribution to CRC patients.

From this outreach, Fisher worked with Dr. Shinde and Dr. Patel to create the nonprofit Citrus Colorectal Cancer Foundation. The foundation started in June 2021, Fisher’s one-year “cancerversary.”

The foundation offers direction for educational, financial and emotional support for CRC patients, caregivers and the community. The foundation is planning ColonFest ‘24 on March 23 and the second annual Charity Casino Night in April.

A New Survivor Lifestyle

Currently, there are more than one million colorectal cancer survivors in the U.S.

Fisher is fully healed three and a half years after her surgery.

“Everything is back to normal, and I can barely see the scars from the surgery,” she said.

A self-proclaimed chocoholic and a junk food junkie, Fisher adopted a healthier lifestyle, eating whole grains, fruits and vegetables and avoiding too much red meat, sugary foods and drinks.

“I lost 25 pounds after my surgery and recovery,” she said. “I feel like if I eat junk food then my cancer might come back.”

Even more so than diet or exercise, experts recognize regular colon cancer screening is the most effective way to prevent colorectal cancer. Fisher said she gets all her health screenings on time and doesn’t self-diagnose health conditions anymore.

Fisher, now 57, advises people not to make excuses and get screened on time.

“There are many types of colon cancer screening available these days, but I always recommend a colonoscopy,” Fisher said.

During a colonoscopy, your doctor can find and remove any polyps — often before they become cancerous. Colonoscopy is the only screening method that can detect and prevent colorectal cancer.

If you choose to take a stool test and receive a positive result, you need a follow-up colonoscopy to determine the cause.

Fisher keeps tabs on her family’s health screenings. One in three people with colorectal cancer have family members who also had it, according to the ACS. People with a family history of colorectal cancer, past polyps or specific genetic cancer syndromes should start screening earlier.

“My family is more aware of possible colon cancer symptoms since it can run in families,” she said. “They have been very supportive of me and my journey.”

In 2025, Fisher is looking forward to celebrating five years with no evidence of disease. She is even considering cheating on her diet.

“Maybe, once I reach the five-year mark, I will celebrate with some chocolate cake,” she said.

After retirement, Fisher said she wants to share the foundation’s mission in person across the U.S.

“I would love to buy an RV and travel all over the country, delivering my pamphlets to every scoping center I can find,” she said. “I would love to have regular support group meetings and help others go through this unwanted journey.”

Schedule Your Colonoscopy

CRC diagnosis in adults 40-49 has increased by nearly 15 percent in the past decade. Younger people tend to have more aggressive tumors that may be more difficult to treat.

Experts recommend colorectal cancer screenings begin at age 45 for adults who are at average risk.

“Prevention is a cure, and we have to prevent bad things,” Dr. Shinde said. “And I tell my patients, if you’re healthy and you want to do all these things in your life, then you are the perfect candidate to get the colonoscopy because it’s the best preventive tool.”

Scheduling your colonoscopy at an ambulatory surgery center (ASC) may be a good option because ASCs are dedicated to specific procedures and may be less expensive.

“A great colonoscopy is not a job of only a physician. It’s a team,” Dr. Shinde said. “It’s a team effort, and it’s a well-oiled machine at an ASC.”

Getting screened is critical to detecting and preventing colorectal cancer. If you are 45 or older and you need a doctor, we can help you find our GI centers located nationwide. Call today to make an appointment.

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This article is designed for educational purposes only. The information provided should not be used for diagnosing or treating a health concern or disease. It is not a substitute for professional care. If you have or suspect you may have a health concern, you should consult your healthcare provider.