Colon Cancer Screening in Fort Smith, Arkansas: Start at 45

If you are at average risk, colon cancer screening should begin at 45, not 50 — the current recommendation from the U.S. Preventive Services Task Force and the American College of Gastroenterology. Colonoscopy is the one test that both finds polyps and removes them in the same visit, and we perform it in our own Fort Smith suite.

Why colon cancer screening now starts at 45

If you are at average risk, colon cancer screening should begin at age 45. That is the current recommendation from the U.S. Preventive Services Task Force and the American College of Gastroenterology, and it replaced the old starting age of 50 a few years ago. The age moved for a simple reason: colorectal cancer is being found more often in adults in their forties. Waiting until 50 was letting real cancers develop in people who could have been screened and protected. According to the American College of Gastroenterology, roughly 1 in 20 people will develop colorectal cancer in their lifetime, and many of them have no family history at all. Colorectal cancer is one of the leading causes of cancer death in the United States for both men and women, and it is one of the very few cancers that screening can actually prevent, not just detect early. Screening does not continue indefinitely; see when to stop screening below.

Who should start earlier than 45?

Some people should be screened before 45, and often more frequently. Talk with us about starting early if any of these apply to you:

• A first-degree relative (parent, brother, sister, or child) who had colorectal cancer or advanced polyps. A common approach is to begin at age 40, or 10 years before the age at which your youngest affected relative was diagnosed, whichever comes first. If a parent was diagnosed at 45, that means starting around 35.
• An inherited syndrome such as Lynch syndrome or familial adenomatous polyposis (FAP). These need much earlier and more frequent screening, and usually genetic counseling. If your family history suggests one, the genetic testing is a cheek swab we can take here in the office and send to a laboratory, rather than a separate referral somewhere else.
• Inflammatory bowel disease, meaning Crohn's disease or ulcerative colitis involving the colon. Surveillance colonoscopy typically begins around 8 years after diagnosis.
• A personal history of colorectal cancer or polyps.
• Past radiation to the abdomen or pelvis, often for a childhood cancer. Colorectal cancer is diagnosed at higher rates among Black Americans, and it is often found at a younger age, which makes screening on time at 45 especially important. And whatever your age: if you have symptoms, screening rules do not apply to you. Symptoms mean you need a diagnostic colonoscopy now, not a screening test later.

What screening is actually looking for

Screening looks for polyps, small growths on the inner lining of the colon, and for early cancers that have not caused symptoms yet. Most colorectal cancers start as a polyp. Polyps grow slowly, often over many years, and most never become cancer at all. But one type, called an adenoma, carries a higher risk of turning into cancer over time. Because the process is so slow, there is a long window in which a polyp can simply be found and removed. That is the whole point. Remove the polyp, and the cancer that would have grown from it never happens.

Your screening options, compared

The best screening test is the one you will actually complete. Here is an honest comparison of the main options.

Colonoscopy

Colonoscopy is the most complete test, because it examines the entire colon and can remove polyps during the same exam. You drink a bowel prep the day before, and the procedure is done under sedation, usually in under 45 minutes. Most patients remember nothing and are back to normal the next day. Strengths: finds and removes polyps in one visit; examines the whole colon; the longest interval between tests. Trade-offs: requires bowel prep, sedation, a driver, and a day away from work; small risks of bleeding or a tear in the bowel wall.

FIT (fecal immunochemical test)

FIT is a stool test you do at home. You collect a small sample and mail it in. It looks for hidden blood, which can come from a bleeding polyp or cancer. Strengths: no prep, no sedation, no time off work; inexpensive and easy. Trade-offs: must be repeated every year; does not find polyps that are not bleeding; a positive result always means you need a colonoscopy afterward.

Stool DNA testing (multi-target stool test)

This at-home test looks for both hidden blood and altered DNA that cells shed into stool. You send an entire sample to a lab in a kit. Strengths: no prep or sedation; done at home; repeated less often than FIT. Trade-offs: more false alarms than FIT, meaning some people are sent for a colonoscopy that turns out normal; does not remove polyps; a positive result always means a colonoscopy.

Other options

CT colonography (a specialized CT scan of the colon) and flexible sigmoidoscopy (an exam of the lower portion of the colon) are also accepted screening tests in some situations. A blood-based screening test is now available as well, but current guidance generally reserves it for people who decline the more accurate options. Dr. Herraka will tell you where these fit for your situation.

How often each test is repeated

The interval depends on the test and on what it finds:

• Colonoscopy, normal, average risk: typically every 10 years
• Colonoscopy after small, low-risk polyps: typically every 7 to 10 years
• Colonoscopy after multiple, larger, or higher-risk polyps: often every 3 to 5 years
• FIT: every year
• Stool DNA testing: typically every 3 years
• CT colonography: typically every 5 years Any stool test only counts as screening if you actually repeat it on schedule. A FIT done once, four years ago, is not screening. It is a memory. Colonoscopy's long interval is one of the main reasons many patients choose it.

When to stop screening

Screening does not continue forever. Routine screening is generally recommended through age 75. Between ages 76 and 85, whether to keep screening becomes an individual decision based on your overall health, your prior results, and your own preferences, and Dr. Herraka will talk that through with you honestly. Past age 85, screening is generally not recommended, since the time it would take for a new polyp to become a threat usually exceeds a person's remaining life expectancy at that point. These are general ranges, and your own health history can shift them in either direction.

What happens if a stool test comes back positive

A positive stool test is not a cancer diagnosis. It means something in the sample needs to be explained, and the only test that can explain it is a colonoscopy, done promptly, not eventually. A positive result followed by no colonoscopy leaves you with all of the worry and none of the protection. Call us with the result and we will start with an office visit, so Dr. Herraka can go over your history and your result before your colonoscopy is scheduled. We take that step in our on-site endoscopy center, and the whole question of what a positive result means, how the billing works and how the two tests actually compare is set out on colonoscopy vs. Cologuard.

Colorectal cancer in Arkansas and the River Valley

According to CDC state cancer statistics, Arkansas has ranked among the states with higher-than-average colorectal cancer death rates and lower-than-average screening rates. Those two facts are connected. Several of the conditions that raise colorectal cancer risk are also more common here than in the country as a whole, obesity, type 2 diabetes, and smoking among them. Being overweight and having type 2 diabetes are recognized risk factors for colorectal cancer, and they are the same conditions that drive fatty liver disease. If that describes you, our medical weight loss program addresses those risks directly, alongside your screening. Distance and time off work are real barriers in the River Valley too. That is part of why we perform procedures in our own suite in Fort Smith, with scheduling we control, for patients from Van Buren, Greenwood, Alma, Barling, Charleston, and from Poteau and Sallisaw across the Oklahoma line.

Symptoms you should never wait on

Screening is for people without symptoms. If you have any of the following, call us rather than ordering a home test:

• Blood in the stool, on the toilet paper, or in the bowl
• A change in bowel habits lasting more than a few weeks
• Stools that have become narrow
• Ongoing cramping, gas, or belly pain
• A feeling that you cannot fully empty your bowels
• Unexplained weight loss, fatigue, or low iron (anemia) Hemorrhoids are the most common cause of rectal bleeding, and they are very treatable; we offer in-office hemorrhoid banding. But polyps and colorectal cancer can bleed in exactly the same way. Get the bleeding checked first, then get the hemorrhoids treated.

Cost & insurance

Most health plans cover colon cancer screening as preventive care, which for many patients means no out-of-pocket cost when the test is billed as screening. The distinction that matters is screening versus diagnostic. Screening means no symptoms, average risk, and due by age or interval. Diagnostic means the test is being done because of a symptom, or on a shorter surveillance schedule after previous polyps or cancer, and that is billed under your regular medical benefits, so a deductible or coinsurance may apply. Two things worth knowing: if a polyp is found and removed during a screening colonoscopy, most plans still treat the exam as preventive, and Medicare has been phasing out the coinsurance that used to apply in that situation. And, as above, a colonoscopy after a positive stool test is now generally treated as part of screening. We accept Medicare, Arkansas Medicaid, Oklahoma Medicaid and most major commercial plans (full list), with self-pay pricing available for elective services. Our team verifies your benefits before your date; see the insurance page, and confirm the details with your own insurer as well.

Schedule your colon cancer screening in Fort Smith

If you are 45 or older and have never been screened, this is the appointment to make. Call Digestive & Liver Center of Arkansas at (479) 242-2888 to schedule at our Main Clinic, 3416 Old Greenwood Rd, Fort Smith, AR 72903, open Monday through Friday, 8:00 a.m. to 5:00 p.m. Most patients can schedule directly, and our team will verify your benefits before your date.