Good News About Colon Screenings
Most people don’t give their colon a second thought until it’s time for a colonoscopy. If you’ve been procrastinating, there’s some good news for you. “If you have a normal colonoscopy at age 65, meaning that they found no polyps, no cancers, you don’t need another colonoscopy until you are 75,” says gastroenterologist Folasade May, MD, associate professor of medicine in at David Geffen School of Medicine and associate director of the UCLA Kaiser Permanente Center for Health Equity in the UCLA Jonsson Comprehensive Cancer Center.
Colorectal cancer is the third-leading cause of death from cancer for people ages 65 and older. However, it’s largely preventable with regular screenings. This generally slow-growing cancer often begins as a small growth called a polyp inside the colon or rectum. Finding and removing polyps can prevent colorectal cancer, and doing that is a standard part of a colonoscopy. “We find a polyp in about 50 percent of people who have a colonoscopy,” she says. “The type of polyp that has the highest potential to progress into colon or rectal cancer is called an adenoma, and about 25% of people have an adenoma. Those are the people who will need a colonoscopy every three to seven years. Very rarely does a person need one every year.”
At-Home Screening Options
People who avoid colonoscopy likely do so because of its invasive nature and the upfront preparation. It includes drinking about a gallon of liquid laxative prior to the exam to clean the colon. Because a sedative is involved during the test, people need to arrange for transportation. But colonoscopies are not the only way to effectively screen for colorectal cancer. Every day your colon sheds cells into your stool, including abnormal colorectal cancer cells. At-home stool tests can detect those abnormal cells.
At-home tests are typically recommended for people at average risk for colorectal cancer. This is generally defined as people without major risk factors, previously detected adenomas, and without a family history of colorectal cancer.
An at-home stool test known as the multi-targeted FIT-DNA test (e.g., Cologuard) uses highly sensitive laboratory methods that can detect abnormal DNA changes in stool samples. The Food and Drug Administration has also approved another at-home test called a fecal immunochemical test, or FIT. Though the accuracy of these two tests varies somewhat, both detect cancer at similar rates, according to results presented during the Scientific Forum at the American College of Surgeons Clinical Congress 2022. The costs vary significantly, though; FIT is about $24 per test, and FIT-DNA costs about $121 per test (and up to $650 without insurance). However, the tests are usually covered by Medicare and most insurers.
At-home stool tests are convenient, simple, and require no bowel prep. The kits provide everything you need to collect the sample and ship it back to the lab. The tests require a physician’s prescription, and Dr. May says they need to be repeated every one to three years. If abnormalities are found in an at-home test, a colonoscopy is the next step.
Colon Cancer Risk Factors
The risk of developing colorectal cancer is influenced by both environmental and genetic factors. Risk factors include:
• Increasing age
• Family history of colon or rectal cancer
• Previously found colorectal adenoma
• Inflammatory bowel disease
• Diabetes
• Obesity
• Smoking cigarettes and drinking alcohol
• Eating red or processed meats
• History of abdominopelvic radiation (e.g., for prostate disease)
Studies show that Black Americans, Native Americans, and Alaskan Native individuals have among the highest incidence and mortality rates for colorectal cancer of all racial and ethnic groups in the United States. In addition, people with the lowest socioeconomic status are 40% more likely to be diagnosed with colorectal cancer than those with the highest socioeconomic status.
To improve screening among these and other underserved groups, an $8M innovative national initiative was launched by Stand Up To Cancer in 2021. UCLA Health has been named a key partner, with Dr. May appointed as a national co-leader. “I’m all about prevention and am thrilled to be part of this team,” she says. “We are working with clinics to help underserved people by mailing at-home stool tests directly to patients to hopefully bring up the overall screening rates.”
Keeping Your Colon Healthy
A healthy diet helps maintain bacteria and other microbes in the gastrointestinal (GI) tract that are needed for a well-functioning immune
system. By keeping your gut healthy you keep your colon healthy and reduce some common frustrations such as constipation and diarrhea. “Eat a high-fiber diet rich in leafy greens, fresh fruits, and grains,” advises Dr. May. “I don’t tell people to completely cut out processed and red meats, but rather to limit them. For example, don’t indulge at the charcuterie board more than once a month or so.”
Water is also essential to colon health. Dehydration is a leading cause of that constipation. Older adults, however, may not sense thirst as readily as they used to. That’s why Dr. May recommends carrying around a refillable water bottle. “I have a 90-year-old veteran patient who says he’s never thirsty,” she explains. “So, I suggested he set his phone alarm to periodically remind him to drink water. We even found a fun alarm that sounds like bubbling water.”
Regular exercise helps keep your GI tract happy, too. Just 20 minutes a day of brisk walking can help stimulate your colon to move things along.
Finally, if you’re tempted to “clean out” your GI tract with a cleanse or colonics, don’t. “There’s no health benefit to ingesting something to clean out the colon or rectum,” says Dr. May. “It can lead to dehydration, depletion of electrolytes, and colonics carries the risk of bowel perforation, which can require surgery to fix.”
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