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By Dr. Matthew Swain, Chief Medical Officer Colorectal cancer screening might seem scary, but it’s a simple, painless procedure that saves many lives each year. “Colorectal” refers to anything in the lower part of the digestive tract, that is, the colon and rectum. Colorectal cancer screening is a way to find cancer before it becomes life-threatening. According to the U.S. Preventive Services Task Force, people with average risk should have colorectal cancer screenings beginning at age 45. Why is screening so important? Colorectal cancer often begins to develop without detectable symptoms, and there’s been a significant rise in colorectal cancer among people under age 50. In 2020, an estimated 1,388,422 people were living with colorectal cancer in the U.S., according to the National Cancer Institute. Early detection leads to better options and outcomes. If you avoid getting screened, you might not seek medical attention until you show severe signs of cancer, like persistent bleeding from your bottom. At that point the cancer will require more intensive treatment or might not be treatable at all. It’s always better to stay in front of it. There are two common screening types: stool-based tests and colonoscopies. Stool-based tests include the guaiac-based fecal occult blood test (gFOBT), which uses a chemical to detect blood in the stool, and the fecal immunochemical test (FIT), which uses antibodies to detect blood in the stool. There is also a FIT-DNA test, which identifies altered DNA that may indicate precancerous cells. For these tests, the patient submits a stool sample for lab analysis. Stool-based screening must be repeated every year or every three years, depending on the type of test. Colonoscopies are the gold standard for colorectal cancer screening. During a colonoscopy, the patient is under anesthesia while a doctor (usually a general surgeon or gastroenterologist) inserts a flexible camera into their bottom. This allows the doctor to look directly at the inside of the colon and rectum. If they see any polyps, they snip them and send samples to the lab. Polyps are small clumps of cells; they’re often harmless, but some can develop into cancer over time. If the screening is completely clear, a patient without other risk factors won’t need another colonoscopy for 10 years. Any screening is better than no screening. If you can’t–or don’t want to–get a colonoscopy, definitely do a stool-based test. For almost everyone, I recommend the colonoscopy. Stool-based screenings are less sensitive and less specific, and they don’t remove polyps. If a stool-based test reveals a problem, guess what you have to do? That’s right: get a colonoscopy. Many insurance programs cover one colorectal cancer screening per year. Those who do a stool-based test and a colonoscopy might have to pay out-of-pocket costs. Colonoscopies have come a long way. If you’ve heard horror stories about colonoscopy prep or the procedure itself, you should know this isn’t your father’s colonoscopy—things are much easier and more pleasant these days. You’ll prepare by drinking electrolyte solution with a laxative to clean out your system the night before. Don’t go making any plans for that evening! The next morning, you’ll have the colonoscopy at a hospital or outpatient surgery center. You’ll be given anesthesia, and you’ll wake up after the procedure is over. You should feel no discomfort and will typically go home 2-3 hours after your appointment time. Usually, you’ll get lab results within two weeks. Then you and your physician can discuss next steps, which may simply be when to schedule your next screening. Contact your primary care provider to schedule a screening. If you don’t have a primary care provider, reach out to a federally qualified health center like MCHC to establish one. If you are at higher risk of developing colorectal cancer, ask your provider when you should begin screenings. Risk factors include inflammatory bowel disease, family or personal history of colorectal cancer or colorectal polyps, and lifestyle factors like lack of physical activity or a diet low in fruits, vegetables, or fiber. Colorectal cancer screening is equally important for men and women. To reduce your risk of developing colorectal cancers, stay active, drink plenty of water, and eat lots of fruits, veggies, and fiber. I tell patients about “Dr. Swain’s poop triangle”: water, walking and wood (where wood is fiber). It leads to a happy digestive tract. Even with the healthiest lifestyle, colorectal cancer remains a risk. Whether you’re nervous about a colonoscopy or you’ve been too busy to schedule it, remember that regular screening gives you the best chance at the best outcome. Most patients leave their colonoscopy saying the same thing I did after my first one: “It really wasn’t that big a deal.” Dr. Matt Swain is the chief medical officer at MCHC Health Centers—a local, non-profit, federally qualified health center offering medical, dental, and behavioral health care to people in Lake and Mendocino Counties.