Confused about when to begin colon cancer screening? Dr. Aasma Shaukat reviews the latest screening guidelines for those at average risk and how family history can shift recommendations even earlier. Dr. Shaukat also shares practical advice for talking with your doctor about colon cancer screening and tips for planning for a colonoscopy.
Dr. Aasma Shaukat is Professor of Medicine and Gastroenterology and Director of Outcomes Research in the Division of Gastroenterology and Hepatology at NYU Grossman School of Medicine. Learn more about Dr. Shaukat.
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Transcript
Jamie Forward:
Dr. Shaukat, let’s shift to screening guidelines. I feel like it changes here and there. But can you tell us about the current recommendation for colon cancer screening?
Dr. Aasma Shaukat:
So, we update the guidelines periodically based on accumulating literature. The last updates were in 2021. And that was looking at this alarming trend of rising incidents, meaning rising cases of colorectal cancer in individuals younger than age 50. And that’s still a worrisome trend that we’re monitoring very closely. So, in light of that trend, the guidelines in 2021 dropped the screening age for average-risk men and women. Basically, if they’re not having any symptoms, they don’t have any family history or any high-risk conditions, to start at age 45. And that’s for men and women, all races, ethnicities, and geographic areas. So, starting at age 45, they should undergo colon cancer screening.
And there are multiple options, as we discussed, as a colonoscopy can be done, or one of these stool tests, or now, a blood test. So, there are plenty of options.
Jamie Forward:
Okay. And are there variations based on gender, race, and family history? Would it go lower based on any of those?
Dr. Aasma Shaukat:
Right. So, the one thing that changes the recommended age is family history. So, family history of colon cancer or these advanced pre-cancerous polyps in a first-degree relative, meaning either parents, siblings, or children. Then the guidelines are to start screening even earlier, starting at age 40.
Or 10 years younger than the youngest first-degree relative affected. Again, if there are multiple first-degree relatives or multiple first- and second-degree relatives, then talking to the provider about the family history is really important.
Because that tips us towards even more increased risk states, what we know as hereditary GI cancer syndromes. Where screening may become important at even earlier ages, starting at age 20, almost.
So, it really makes a difference. So, first, know your family history, if possible. Again, not always feasible in all situations. And then, do talk to your provider about it. And then update that family history every few years. Those are some of our recommendations.
Jamie Forward:
Does hereditary testing or genetic counseling come in as a screening tool here at all?
Dr. Aasma Shaukat:
Absolutely. So, if we’re getting a history of multiple first- or second-degree relatives with colorectal cancer, say, a parent, a grandparent, siblings, siblings, and cousins. So, then there’s certain criteria that we look for. But generally, that is an indication that there needs to be a more thorough discussion and err on the side of getting genetic testing done.
And getting a consult from a genetic counselor. Basically, they advise you of risks/benefits.
Go over what the results may look like and the process. And then the test is ordered. And those assays are getting more sensitive. So, certainly, if there’s a family history, it’s very much important to think about genetic testing.
Jamie Forward:
Okay. And be proactive. You’ve got to speak up.
Dr. Aasma Shaukat:
Yes. Absolutely. Yes. We need to be our own advocates. And sometimes the providers are busy, they forget to bring it up. Or they think something’s done, but it’s not actually done. So, be your own advocate and definitely have this conversation.
Jamie Forward:
What sort of questions should patients be asking their healthcare team about this?
Dr. Aasma Shaukat:
Right. So, am I eligible for colon cancer screening? And what modality is right for me? So, for average-risk individuals, sure, stool testing and colonoscopy are appropriate. But as we were discussing, somebody with a family history or other conditions, actually, only colonoscopy is recommended. So, which modality is the right one for me? And then, what are the pros and cons of these different modalities? And then, based on that, make an informed decision.
Jamie Forward:
Sure. And it sounds like talking to your primary care physician first might be best here, right?
Dr. Aasma Shaukat:
Absolutely. Yeah. And then, once the test is ordered, and either you get this toolkit or you get the colonoscopy scheduled, again, being proactive. Scheduling the date that works for you. Then getting all the steps lined up that you need in terms of, is it a convenient time for you for colonoscopy? Do you have a driver that could pick you up? Do you understand everything about the day before, where there’s a prep and kind of a liquid diet?
So, being kind of proactive about the process and getting it completed, I think, is the most important thing.