Colon cancer is the second leading cause of cancer-related deaths in the United States. Reducing the number of deaths from colon cancer depends on detecting and removing pre-cancerous colorectal polyps, as well as on detecting and treating cancer in its early stages. In fact, colorectal cancer can be prevented by removing pre-cancerous polyps. These polyps may be present in the colon for years before invasive cancer develops.

There are several tests used to screen for colon cancer. Your physician may recommend one test or a combination of tests, depending on your risk factors and health history.

When colon cancer is diagnosed in its early (or localized) stage, survival rates are high, and only about 10 percent of patients will die within five years. Once the disease progresses beyond that stage to a regional stage (it has spread within the colon, but not to other organs), about 35 percent of patients will die within five years. When the disease is diagnosed at an advanced stage (when cancer has spread beyond the colon to distant sites), death rates are high - about 92 percent of patients will die within five years.

Description of screening tests

The screening tests for colon cancer are:

• Digital rectal examination (DRE)
• Fecal occult blood test (FOBT)
• Sigmoidoscopy
• Colonoscopy
• Barium enema with air contrast

For more information about these tests, visit the College of American Pathologists Web site at www.cap.org.

Who is at risk?
The risk of developing colon cancer generally increases as people get older. Men and women 50 years of age and older are at higher risk for developing colon cancer. African-Americans are more likely than Caucasians to be diagnosed with colon cancer at a more advanced stage and are more likely to die from it.

Aside from age, other risk factors for colon cancer include having:

• Inflammatory bowel disease
• A family history of colon cancer or colorectal polyps
• Certain hereditary syndromes (such as familial adenomatous polyposis [FAP] or hereditary nonpolyposis colon cancer [HNPCC, also known as Lynch syndrome])

What tests should I have done?
There are several screening options for early detection of colon cancer. Beginning at age 50, men and women should follow one of these options:

• FOBT every year
• Flexible sigmoidoscopy every five years
• Double contrast barium enema every five years
• Colonoscopy every 10 years

Note: Flexible sigmoidoscopy can be combined with a yearly FOBT. All positive tests should be followed up with colonoscopy. Work with your physician to outline the best plan for you.

Individuals at a moderate or high risk should talk with their doctors about different screening schedules.