Colorectal Cancer is Preventable.
Screening and Prevention are NOT the Same.
What to Know About
Cologaurd vs Colonoscopy
Everyone agrees that screening for colorectal cancer is important—it can truly save lives. But there’s still some debate about the best age to start and which screening test is best.
You may have heard the saying that the best screening test is “the one that gets done.” That’s true—but it’s also important to understand that not all these tests are the same.
Most screening tests are designed to detect cancer. Sometimes they are positive even when cancer isn’t present (these are called false positives), or in some but not all cases large polyps are sufficient to make a test positive. But overall, their main goal is to find cancer—not prevent it. Colonoscopy is the gold standard test others are compared to. If any other screening test is positive, the next step is always a colonoscopy.
So what about colon polyps?
More than 95% of colorectal cancers grow from polyps. At age 50, approximately 25% of people have polyps and that percentage increases as we age to over 50% at age 70. Wouldn’t it be great to find and remove polyps before they ever become cancer? That’s exactly what colonoscopy does. Because it allows doctors to detect and immediately remove potentially precancerous polyps, colonoscopy is the only screening test that can reduce your risk of ever developing colorectal cancer.
Other tests—like Cologuard, FIT (fecal immunochemical test), gFOBT (guaiac-based stool test), or the Shield blood test—are less invasive, but they don’t reliably detect precancerous polyps. They also need to be repeated more often (every 1–3 years) and are not for people at higher risk for colorectal cancer.
Before choosing a screening test, it’s important to know your personal risk level.
Colonoscopy is appropriate for both average- and high-risk individuals, and if the results are normal, it doesn’t need to be repeated for 10 years. After 10 years, since you will know you are not at high risk, you may decide that another screening option fits you better—and that’s completely fine. The key is choosing a screening plan that works for you and sticking with it.
COLON CANCER IS NOW THE LEADING CAUSE OF DEATH UNDER AGE 50
In recent decades, colorectal cancer has been occurring more often in younger adults, which has changed how we think about screening. While rates have declined in older adults—largely due to screening by colonoscopy—they’ve been steadily increasing in people under 50. Because of this shift, the recommended starting age for average-risk screening has been lowered from 50 to 45. The goal is simple: catch cancers earlier—or better yet, prevent them entirely by finding and removing pre-cancerous polyps.
The reasons behind this trend aren’t completely understood. Most experts believe it’s not a single cause, but rather a combination of influences that begin earlier in life and gradually increase the risk of developing colorectal cancer. Changes in lifestyle over the past few decades seem to play an important role, including diets higher in processed foods and lower in fiber, increasing rates of obesity, and less physical activity. There’s also growing interest in the role of the gut microbiome, which can be influenced by diet, antibiotics, and environmental exposures. Together, these factors may promote inflammation or other changes in the colon that increase cancer risk.
Colon cancer is rising rapidly in young adults. If you have questions or concerns about your colon health or are experiencing symptoms, contact our office today.