Colorectal Cancer (CRC) affects literally millions of Americans. Everybody knows about it, and everybody knows how important it is to be screened for it beginning at age 45. Also, everyone should be aware of the importance of knowing if a first degree relative (parent or sibling) has, or has had, CRC. There probably is no more important bit of one’s personal and family history than that. There is a strong correlation between a parent or sibling having CRC and an individual being diagnosed with it. Family history is, then, one of the biggest factors that should prompt people to begin screening.
Recently, medscape.com published an article in which four medical GI oncologists who treat CRC patients were interviewed to share their opinions about “the American Cancer Society’s newly released updated CRC screening guidelines.” All four of these physicians said the same thing, and it is summarized here. The facts about CRC screening are as follows:
- CRC screening is intended for asymptomatic patients and should begin at age 45.
- Patients who have rectal bleeding, a change in their bowel habits, unexplained weight loss or any abdominal pains that are of concern, should have a colonoscopy regardless of age. Don’t assume the symptoms are caused by a benign condition just because you’re younger.
- Fecal occult blood tests are non-invasive, and they do not definitively diagnose CRC. They are only “the first step.”
- A positive stool test should always be followed by a colonoscopy.
- “While the sensitivity of tests using stool…..have [has] improved significantly over the past decade, they have not replaced colonoscopy as the definitive method for proving someone has a cancer in the colon or rectum.”
- “ A high….number of people [are] getting a concerning test result, and then opting to not complete the full assessment when a….colonoscopy is being recommended.”
- “Any screening option is better than no screening.”
- “Blood-based tests do not meaningfully detect precancerous advanced adenomas.”
- A big misconception is that a negative stool or blood test means that there is no possibility of colorectal cancer.
- A family history of CRC means a patient should be screened earlier and often.
- Blood tests do not replace colonoscopy, and a positive stool test is not needed before a colonoscopy is done.
Bottom Line: CRC screening should begin at age 45, or any time a person has rectal bleeding, a change in bowel habits, unexplained abdominal pain, or unexpected weight loss. The gold standard for detection of CRC is colonoscopy. When to repeat colonoscopy is determined by the results of the prior study. Fecal occult blood testing does not replace the accuracy of direct visualization of the colon’s inner lining. “Colonoscopy… as the best screening method to avoid cancer…..The best screening test is one that gets done.”
Colonoscopy is king. It’s the best test, and the only test to find, treat, and cure colorectal cancer. If you’re 45 or older and haven’t had a colonoscopy, you’re making a big mistake to put it off. They are done every hour of every day, so don’t delay. You’re next in line.
Reference: Atreya CE, Bernabe C, Lieu C, Lou E. Decoding the Updated CRC Screening Guidelines. medscape.com 2026 September 4.
