غربالگری سرطان روده؛ از چه سنی باید شروع کنیم وآیا همه به کولونوسکوپی نیاز دارند؟ دکتر حسین یوسف فام

At what age should colon and rectal cancer screening begin? Should everyone have a colonoscopy or can a stool test also be a good option? Should people with a family history of colon cancer be screened earlier? In this program from the Erfan Niayesh Hospital Medical Talks series, Dr. Hossein Youseffam, a colorectal surgery fellow, explains colon cancer screening methods, the age at which screening should begin, and the difference between colonoscopy and stool tests. What is colon cancer screening? Screening means examining people who do not yet have symptoms, with the aim of identifying precancerous polyps or cancer in the early stages. Many colon cancers begin as polyps, and removing polyps during a colonoscopy can prevent them from turning into cancer. The presence of symptoms such as blood in the stool, anemia, weight loss, or a change in bowel habits is no longer considered screening, and the person needs a medical evaluation to determine the cause of the symptoms. At what age does screening begin? Many authoritative guidelines recommend that people at average risk begin regular colon cancer screening at age 45 and usually continue until age 75. The decision to continue screening at ages 76 to 85 should be based on general health, life expectancy, screening history, and the opinion of your doctor. A person at average risk is usually someone who does not have a personal history of advanced colon cancer or polyps, inflammatory bowel disease, a significant family history, or a known genetic syndrome. Should everyone have a colonoscopy? No. There are several validated screening methods for asymptomatic, average-risk people. The choice of method depends on the level of risk, individual preference, availability, cost, and the ability to repeat the test regularly. Common methods include: Fecal occult blood test or FIT, usually every year Multi-target stool tests at specific intervals Colonoscopy, usually every 10 years if results are normal and risk factors are not present CT colonography or virtual colonoscopy in some people Sigmoidoscopy in appropriate circumstances Colonoscopy and FIT are the main screening methods. The most important thing is to do the chosen method at the right time and regularly. What should you do if the stool test is positive? A positive stool occult blood test does not mean a definitive diagnosis of cancer. Hemorrhoids, polyps, or other causes may also cause bleeding; however, a positive result should be followed up with a colonoscopy. Repeating a stool test instead of a colonoscopy is not a complete investigation of the cause of a positive result. What are the benefits of a colonoscopy? Colonoscopy allows for a complete view of the colon, sampling of suspicious lesions, and removal of many polyps in the same visit. However, colonoscopy requires bowel preparation and is usually performed under sedation. The risk of bleeding or perforation of the bowel is low, but it can occur, especially after polyp removal. If the colonoscopy results are normal, a person at average risk usually does not need to have it repeated for several years; however, the interval between screenings should be determined based on the quality of the examination and the doctor's opinion. Who should be screened earlier? People with the following conditions may need to start earlier, have colonoscopies more frequently, or have them more frequently: A history of colon cancer or advanced polyps in a parent, sibling, or child A close relative who was diagnosed at a young age A personal history of polyps or colon cancer Long-standing ulcerative colitis or Crohn's disease of the colon Inherited syndromes such as Lynch syndrome or familial adenomatous polyposis A history of radiation therapy to the abdomen or pelvis in some patients The age of onset and screening intervals are not the same for these people and should be determined on a case-by-case basis. Does family history always mean high risk? No. The level of risk depends on the number of affected relatives, the degree of relationship, and their age at diagnosis. It is more important to have a first-degree relative diagnosed, especially at a young age. For this reason, it is important to provide the doctor with the name of the affected person, the type of cancer, and the age of diagnosis. Should people younger than 45 also be screened? Routine screening for low-risk individuals begins at age 45, but there is no age limit for symptoms. A person with blood in their stool, iron deficiency anemia, unexplained weight loss, persistent abdominal pain, or a persistent change in bowel habits should be evaluated even younger. The increase in bowel cancer in some younger groups has also made it more important to pay attention to these symptoms. Until what age does screening continue? Regular screening is recommended for people aged 45 to 75 at average risk. For those aged 76 to 85, the decision should be individualized, and after age 85,...