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An Arlington man waited nine years after his father died of colon cancer before undergoing a colonoscopy. When he finally had the procedure, doctors found stage 3 colon cancer.
His father, who was in his 80s, had died after the disease went undiagnosed until his intestines were completely blocked. Genetic testing later found two chromosome variants associated with increased susceptibility to colon cancer.
The man’s widow urged their six adult children to get colonoscopies. Five initially followed that advice. Two children in their 30s had polyps, while three had no concerning findings.
The sixth child relied on a test that detects blood in stool. He had no symptoms and believed the noninvasive result meant he was fine. COVID-19, insurance complications and other issues contributed to further delays.
He now has a blunt message for others: “Don’t wait.”
Survey finds widespread confusion
March has been recognized as Colorectal Cancer Awareness Month since 2000. A national MedStar Health survey found significant gaps in public knowledge about screening:
- Seventy-seven percent did not know that screening generally begins at age 45 for people at average risk.
- Seventy-five percent did not know that an average-risk person with normal findings may go 10 years between colonoscopies.
- Forty-seven percent believed everyone needs the procedure every five years.
- Only 13% could identify all the symptoms of colorectal cancer.
- Thirty-six percent of adults 45 and older had not undergone a colonoscopy.
- Forty percent cited a lack of family history as a reason for delaying screening.
Dr. Nikiya Asamoah, a board-certified gastroenterologist affiliated with MedStar Washington Hospital Center, said the proper interval depends on the individual.
Family cancer history, inflammatory bowel conditions and the number of polyps discovered during a previous procedure can all affect the schedule. Some people need another colonoscopy within one to three years, while those without risk factors or polyps may wait 10 years.
For people who are not at high risk, the recommended starting age is 45—not 40. A person’s family history can lead doctors to recommend earlier screening, while the results of that person’s own colonoscopy generally guide the timing of later procedures.
Asamoah said concerns about bowel preparation and anesthesia are among the most common reasons people delay. Updated preparation guidance may make the process easier: Patients can have a light breakfast one day before the procedure, reducing the fasting period, and may be offered a two-liter preparation instead of the traditional four-liter version.
Screening options and risk factors
The Cologuard stool test is a useful screening tool with greater than 90% sensitivity for detecting an existing cancer, Asamoah said. The appropriate screening method and schedule, however, depend on a patient’s risk factors and medical history.
Genetics and multiple environmental or lifestyle factors may contribute to colorectal cancer risk. Asamoah recommends a balanced diet featuring fruits, vegetables and lean protein, along with regular aerobic exercise.
African Americans have a higher incidence of colorectal cancer than most other racial and ethnic groups, with health and socioeconomic disparities among the contributing factors. Based on American Cancer Society estimates for 2025, American Indian and Alaska Native people have the highest incidence, while Asian and Pacific Islander people have the lowest.
Fiber gummies are not necessarily a substitute for fiber-rich foods. Asamoah said the supplements often contain excess sugar or sweeteners without providing a significant amount of fiber. Fruits and leafy green vegetables supply both soluble and insoluble fiber.
Other preventive steps include limiting red and processed meats and alcohol, avoiding smoking and maintaining a high-fiber diet. Persistent changes in bowel habits, blood in the stool, unexplained weight loss or abdominal pain should prompt a conversation with a doctor.