Although the overall death rate from colorectal cancer has been on the decline in recent years, it remains the second leading cause of cancer deaths in the United States. There has also been an increase in colorectal cancer-related death for people younger than 55, and an increase in diagnosis in patients between the ages of 40-49 over the past decade, according to the National Cancer Institute.

With this new upwards trend, national health guidelines recently lowered the initial screening age from 50 to 45. This change means that an additional 21 million Americans will be eligible for screening.

In the Military Health System, the estimated impact of the lower age recommendation is that over 200,000 additional beneficiaries will need to be screened for CRC, according to Dr. Chin Hee Kim, deputy chief of specialty care support of the Defense Health Agency Directorate of Medical Affairs.

The new DHA guidelines also offer various CRC screening options, including expanding the use of a stool-based test known as Fecal Immunochemical Test, or FIT, as an alternative to a colonoscopy.

“Colorectal cancer screening, and preventive screenings in general, are important for overall wellness and healthy living. The MHS strives to implement evidence-based strategies to optimize both prevention and early detection of serious diseases before they become major,” Kim said. “Preventive care helps to sustain your health, meet standards for duty fitness, and maintain medical readiness.”

There is a 5-year survival rate of approximately 90%, if colorectal cancer is detected early.

When Should You Be Screened for Colorectal Cancer?

“Beginning at age 45, all average-risk men and women should undergo routine CRC screening,” said Kim.

Patients are considered to be at average risk if they:

• Do not have a personal history of CRC or certain types of polyps.
• Do not have a family history of CRC.
• Do not have a personal history of inflammatory bowel disease.
• Do not have a confirmed or suspected hereditary CRC syndrome.

According to Kim, CRC might not cause symptoms right away, but if you have one of these symptoms, you should see a doctor.

• Rectal bleeding with bright red blood.
• A change in bowel habits, such as diarrhea, constipation, or narrowing of the stool that lasts for more than a few days.
• A feeling that you need to have a bowel movement that's not relieved by having one.
• Blood in the stool, which might make the stool look dark brown or black.
• Cramping or abdominal pain.
• Unintended weight loss.

Kim said, “The screening method for CRC is based on shared decision making between the provider and the patient after discussing risks and benefits of all available screening options. A colonoscopy can be offered for both average risk and high-risk patients. The goal is to inform our beneficiaries about all screening options, including FIT, to optimize overall CRC screening for the MHS.”

Increasing Usage of FIT as a Tool

“While we have made great strides in colon cancer screening and prevention over the last several decades, around one-third of the U.S. population is not up-to-date on testing. By educating patients and providers about evidence-based alternatives to colonoscopy such as FIT, we are striving to expand access to screening to as many patients as we possibly can,” said U.S. Navy Lt. Brett Sadowski, program director of gastroenterology fellowship at the Navy Medicine Readiness and Training Command in San Diego.

Of the existing stool-based testing available, FIT is one of the most sensitive and cost-effective screening tests for colon cancer screening. The FIT is an easy to use, non-invasive, stool-based test that can be done at home.

The test must be done every year, but many people find them more convenient than other tests like a colonoscopy,” said Kim.

Instead of having to undergo an invasive procedure like a colonoscopy, one can collect their stool sample at home and mail it to the lab in provided packaging. Importantly, if a positive test result occurs, the patient should understand that a colonoscopy needs to be performed to complete the screening process. Like all screening tests, patients should be aware of following limitations of FIT, which include:

• May miss tumors that bleed in small amounts or not at all.
• Lower sensitivity to detect a potential pre-cancerous lesion in the colon.
• Essential need to be repeated annually.

“The MHS is also working with clinicians to communicate and standardize workflow that incorporates the new age recommendation along with the appropriate use of FIT for average-risk patients. Medical logistics is also ensuring that FIT supplies are available at all military treatment facilities,” Kim said.

Lifestyle Changes Could Reduce Risks

Adopting healthy lifestyle habits can lower your risk of these types of cancer.

“Lifestyle factors play a profound role in our ability to impact our gut microbiome to support gut health. For all individuals, but especially for those who are at highest risk, lifestyle factors play an important role in reducing the risk of colorectal cancer,” U.S. Air Force Col. Mary A. Kiel, chief of the Air Force Medical Home Program at Air Force Medical Readiness Agency.

Along with a healthy diet, other “lifestyle factors such as reducing body weight, limiting alcohol, quitting smoking, and engaging in regular physical activity can have a profound positive impact on reducing risk,” said Kiel.

TRICARE Benefits

TRICARE covers colorectal cancer screenings for average-risk beneficiaries beginning at the age of 45 years old. It will cover the following types of screenings:

• Fecal Immunochemical Testing: One stool sample once every 12-months.
• Fecal Immunochemical Testing: Stool DNA tests once every 1-3 years.
• Fecal Occult Blood Testing: Three consecutive stool samples once every 12 months.
• Flexible sigmoidoscopy: Once every 5-years.
• Optical colonoscopy: Once every 10 years.
• Computed Tomographic Colonography: Once every 5 years.
• Flexible Sigmoidoscopy: Every 10 years with FIT every year.

If you have concerns, need more information about colorectal cancer, or meet any of the screening guidelines, it is recommended you talk to your doctor.