Screening for Colorectal Cancer
Colorectal cancer (CRC) is the second-leading cause of cancer deaths in the United States. Most CRC's, and most deaths from
CRC, are preventable by early screening, which is the search for cancer and pre-cancerous growths in patients without symptoms, and
no prior history of CRC.
The most accurate test for CRC screening and diagnosis is colonoscopy. All insurance plans, including Medicare and managed
care plans, cover screening and diagnostic colonoscopies. Colonoscopy carries the advantage over all other screening tests that it is more accurate and offers the therapeutic ability to remove polyps and some early cancers in their entirety,
at the same time as the screening colonoscopy itself, in one session.
Most colorectal cancers begin as a polyp, a small benign growth on the lining of the intestine. The interval between the initial
appearance of a polyp, and its transformation into a cancer, is usually on the order of several years. This allows for the early detection of
polyps at screening, their non-surgical removal through the colonoscope at the same time. It is proven that early removal of polyps
prevents the subsequent development of CRC, if screening is performed in timely fashion, and repeated at regular intervals.
The age at which screening colonoscopy is recommended to begin depends upon the risk of the individual in question. Average-risk
patients are those with no signs or symptoms of CRC, and no known family history of CRC. It is now recommended that average-risk
patients be screened starting at age 50, and then every 5 to 10 years thereafter.
Increased-risk patients should begin screening at an age younger than 50, and these include patients with positive family histories
of CRC. Many CRC's run in families, and the stronger the family history (the more family members affected) the greater the risk for the
individual, and the earlier the screening should begin. Other factors increasing risk for CRC include a personal history of colitis or
inflammatory bowel disease, previous colon polyps or CRC, and some other cancers, including breast and uterine cancers. Evaluation of
a patient with a prior history of CRC or polyps is known as surveillance.
Once a patient develops signs and symptoms of colorectal cancer, "screening" is no longer an option, and the patient should
undergo immediate diagnostic evaluation, including colonoscopy. Common signs and symptoms of CRC include blood in the stool,
change in bowel habits [recent onset of constipation or diarrhea], abdominal pain and/or mass, weight loss, fatigue, and iron-deficiency
anemia. In symptomatic patients, urgent or emergency diagnostic colonoscopy may be indicated, and may require hospital admission,
depending on the severity of symptoms.
Dr. Finkel can usually schedule screening colonoscopies within 2 to 3 weeks of your initial visit - surveillance
colonoscopies within 1 to 2 weeks - and diagnostic colonoscopies on an urgent or emergent basis, as needed.
Expedited appointments are available, but are rarely necessary for screening purposes.
Over age 40, some pre-testing may be necessary before colonoscopy, or medical clearance may be required from your primary care
physician. Pre-testing can be done in Dr. Finkel's office, or by your PCP, for your convenience, or depending on your plan.
Dr. Finkel will be happy to suggest the optimum timing for your colonoscopy, depending on his evaluation of your risk status, and the
presence or absence of any signs or symptoms that may make your individual status higher risk than for routine screening, and requiring
a more expedited evaluation.