More than 150,000 adults in the United States will receive a diagnosis of colon or rectal cancer this year, and more than 50,000 will die from the disease. Among those, Black men and women will be disproportionately affected: they are 20 percent more likely to get colorectal cancer than other groups and 40 percent more likely to die from the disease, according to the American Cancer Society.
There are a number of reasons for these disparities, says Joseph E. Ravenell, MD, associate professor in the Departments of Medicine and Population Health, director of the Cancer Prevention Navigation Program at Perlmutter Cancer Center, and spokesperson for the American Cancer Society. They may include a lack of access to healthcare for those who are underinsured or uninsured; mistrust of healthcare providers, which can stem from negative experiences; lack of awareness about the benefits of screening; and concerns that the tests may be uncomfortable. Racial minorities were also more likely to forego colorectal cancer screening because their primary care physician had not recommended it, a 2015 study in California found.
Most experts recommend Black men and women start routine colorectal cancer screenings at age 45 because of the higher incidence of disease and death. Many experts recommend all adults with average risk, regardless of race, start getting screened at age 45. Colon cancer is usually slow growing and, in most cases, highly treatable in its early stages. “Screening can help detect polyps, abnormal growths on the colon, before they become cancer, or detect cancer early when treatment is most effective,” says Dr. Ravenell.
If a family member—especially a parent or sibling—has had either colorectal cancer or certain types of polyps, your risk of developing the disease is higher. In that case, experts recommend you begin screening even earlier, instead of waiting until age 45.
Talk to your NYU Langone gastroenterologist about your family history of colorectal cancer and your screening options, and then get screened.
Colorectal Cancer Screening Options
Several colorectal screening options are available, but two are most highly recommended by experts, based on effectiveness, cost, and other practical considerations: colonoscopy and the fecal immunochemical test, or FIT test.
Colonoscopy is the screening test people are probably most familiar with. It is also the test recommended for people with a family history of colorectal cancer. During the procedure, the doctor threads a narrow, flexible tube called a colonoscope into the rectum and through the entire colon, or large intestine. A small camera at the end of the colonoscope allows the doctor to view and examine the lining of the colon and rectum.
Although colonoscopy is invasive and carries a very small risk of complications, it is the most thorough test, providing doctors with a clear view of the colon, says NYU Langone gastroenterologist Renee L. Williams, MD, associate professor in the Department of Medicine. “It’s also therapeutic, when necessary. If we find a polyp, we remove it right away. And if we see something abnormal, we can biopsy it.”
For people at average risk who have had normal test results, colonoscopy needs to be repeated only about every 10 years. For people at higher risk, the doctor determines the test frequency.
For some people, colonoscopy is not an ideal option. Preparation takes time: you’re restricted to clear liquid diet the day before the procedure, and you must drink a laxative fluid to fully clean the bowels. And because the test requires you to be sedated, someone must accompany you home afterward. For these and other reasons, you may prefer to use the FIT test, which you can do at home. For this test, you place a small amount of stool on a card and mail it to a lab. The lab examines the stool for blood that can indicate cancer, or precancerous or cancerous polyps.
The FIT test has several benefits for people at average risk of colorectal cancer, says Dr. Williams. “You don’t have to change your diet, it’s noninvasive, carries no risk, and is significantly less expensive than colonoscopy.” However, unlike colonoscopy, it must be repeated every year to be effective. And if a test returns an abnormal or positive result, a colonoscopy will be required.
Learn more about these and other types of colorectal cancer screening tests available at NYU Langone.
Make a Colorectal Cancer Screening Appointment
Making an appointment for colon cancer screening is the first and best step you can take to protect your health. The Adult Medicine Program—Family Health Centers at NYU Langone in Brooklyn offer screening services regardless of income or insurance status. Our Colon Cancer Screening and Prevention Program has locations in Manhattan, Brooklyn, Queens, and Long Island. All NYU Langone gastroenterologists offer a range of colorectal screening tests, as well as expertise to help you determine which is most appropriate for you. But no matter which test you choose, says Dr. Williams, “in the end, the best test is the one that gets done.”