In the United States, colorectal cancer is the third most common cancer and the second leading cause of death. The American Cancer Society estimates more than 95,000 new cases will be diagnosed in 2017. Screening for colorectal cancer is important because when it is found at an early stage, it can frequently be cured.

There are many choices for colon and rectal cancer screening in the average risk population.

Average risk refers to patients without symptoms such as blood in the stool, changes in bowel movements and patients without a personal or family history that puts them at higher risk for colon and rectal cancer such as a personal history of Crohn’s disease or Ulcerative Colitis, or a personal or family history of colon or rectal cancer or polyps.

In general, the tests are divided into two categories: stool based or direct visualization.

Stool-based tests

For stool based tests such as the Hemoccult Sensa and the Fecal Immunochemical Test, a sample of stool is sent to the lab for further evaluation. These tests look for blood in the stool.

Direct visualization tests

There are also direct visualization tests, such as colonoscopy. In colonoscopy, a scope is inserted through the anus and advanced to the cecum (the very start of the colon). The inner lining of the colon wall is visualized to look for polyps (pre-cancerous abnormal growths). These polyps can often be removed during the procedure and prevent a cancer from forming.

How are we doing in Vermont?

You might ask, how are we doing at screening in Vermont? Nationwide, the rate is only 66 percent. In Vermont, we are doing better at 71 percent, but there is still high variability across the state.

So, which test is the best?

The US Preventive Service Task Force found no difference in number of life-years gained and no difference in number of colorectal cancer deaths averted when these above tests are done appropriately. So, the best test is the one that gets done!

Dr. Krista Evans is a general surgeon specializing in colon and rectal surgery at The University of Vermont Medical Center and assistant professor at the UVM College of Medicine in Burlington, VT.

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