Preventing colorectal cancer with free screenings

Colorectal cancer, or cancer of the large intestine or rectal area, is the third leading cause of cancer-related deaths for both men and women in the United States. It is also considered one of the most preventable cancers. With routine screening, unwanted growths in the colon that can develop into cancer, called polyps, can be detected and removed. So why are more than 50,000 people dying from colorectal cancer every year? The answer is simple: people aren’t getting screened.

Jason McKnight, MD, MS, FAAFP, clinical associate professor at the Texas A&M University School of Medicine and director of residency recruitment at the Texas A&M Family Medicine Residency program, discusses the basics of colorectal screening and prevention.

Signs and symptoms

During screening tests such as a colonoscopy, health care providers look for polyps or other abnormalities. Once these potentially pre-cancerous polyps are removed, the likelihood of developing colorectal cancer is reduced. However, even if you receive regular screenings, it’s important to be familiar with common cancer symptoms and warning signs as these symptoms can also be signs of other benign medical conditions.

• Change in bowel habits, such as diarrhea, constipation or narrowing of stool that lasts for more than a few days
• A feeling that you need to have a bowel movement that is not relieved by doing so
• Rectal bleeding
• Bloody stool, which may make it look dark
• Cramping or abdominal pain
• Weakness and fatigue
• Unintended weight loss

“During the early stages of colorectal cancer, you may not notice any symptoms,” McKnight said. “However, it is important to quickly catch the cancer, so timely screenings are important.”

Who should be screened?

Often, the idea of having a colonoscopy fills people with an understandable amount of apprehension. However, the U.S. Preventive Services Task Force recommends people with average risk of colorectal cancer start regular screening at age 45.

For those with a family history of colorectal cancer, McKnight says to talk with your physician about starting screenings even earlier than 45, usually 10 years before the youngest case of advanced polyps or colorectal cancer occurred in your family. Also, if you have had a previous colonoscopy where polyps were removed, you may need another colonoscopy in less than 10 years.

There may be available resources in your community if cost is a barrier for getting screened. “Thanks to a grant from the Cancer Prevention and Research Institute of Texas (CPRIT), we offer free colonoscopies and fecal immunochemical tests (FIT) for people without insurance or people in the Brazos Valley and eastern Texas who cannot afford their deductible for the procedure,” McKnight said.

Colonoscopy preparation

A colonoscopy is usually done in a clinic or hospital setting by a physician with specialized training in the procedure. Your physician’s office will provide the step-by-step instructions, which normally starts about six days prior to the colonoscopy appointment. The afternoon or evening before the procedure, patients will ingest a laxative prep drink. The drinks are designed to clear out your digestive tract to empty the colon. Additionally, patients will be asked to avoid eating solid foods a day before the procedure.

A clean digestive tract allows the physician to get a better view of the entire colon, so even the smallest polyp can be detected. After all, it only takes one polyp to develop into cancer.

What to expect during a colonoscopy

The colonoscopy itself should take less than an hour. Beforehand, the physician will sedate the patient. Depending upon the facility where the procedure is done, the patient may be completely sedated or undergo a conscious sedation.

During the procedure, a colonoscope—a thin, flexible tool with a camera and light attached at the tip—will be inserted through the anus and move slowly through the rectum and colon to look for polyps and cancer. If a polyp is found, it will be removed during the procedure.

After the colonoscopy, patients may need to remain at the clinic before they are released for monitoring and to ensure there are no immediate complications. Because the physician adds air into the intestine during the procedure, patients may experience gas and cramping afterwards. The physician will explain when regular diet and activities can be resumed.

Alternatives to the colonoscopy

While colonoscopies are the most thorough way to detect cancer, some alternatives exist for those who prefer less invasive methods. These screenings often require more frequent testing than a colonoscopy.

Some alternative screening tests:

• CT colonography (also known as a virtual colonoscopy) also uses radiation to detect polyps or cancer. It should be done every five years.
• Fecal occult blood test (FOBT) and fecal immunochemical test (FIT) tests stool samples for hidden traces of blood. In contrast with other alternatives, these at-home stool tests should be done annually.
• Stool DNA test examines DNA in a stool sample for certain gene changes that are present in colon cancer cells. This method of screening should occur every three years.

Lifestyle changes to reduce your risk

Other than regular screenings, you can make additional changes to help reduce your risk of developing colorectal cancer. McKnight recommends you exercise for at least 30 minutes, five days a week to help you maintain a healthy weight, which lowers your risk. He also recommends you try to consume more fiber through vegetables, fruit and whole grains, while limiting your intake of processed meats and alcohol.

“Colorectal cancer can largely be prevented by maintaining a healthy lifestyle and having preventive screenings,” McKnight said. “In fact, research has shown that deaths from colorectal cancer can be reduced by as much as 60 percent with regular colonoscopy.”

That’s why efforts like the Texas C-STEP, run by Texas A&M Health, are so integral. The program, supported by CPRIT, provides financial assistance for colonoscopies or FIT testing to uninsured or underinsured residents in 17 central and five eastern Texas counties. For more information, visit the Texas C-STEP website.

Originally published March 8, 2019; updated March 14, 2023