Our easy-to-read fact sheets provide clinicians with reliable information to share with patients and their caregivers.
Colorectal cancer (CRC), a collective term for colon and rectal cancers, is the third leading cause of cancer-related deaths among men and the fourth leading cause among women in the United States.1
However, there are ways to reduce risk for CRC — and even stop it from spreading. Screening methods are designed to detect and, in some cases, remove precancerous or cancerous growths in the body.
The American Cancer Society (ACS) and the US Preventive Services Task Force recommend that adults at average risk for CRC begin screening at 45 years of age and continue through 75 years of age.2,3
Individuals are considered at “average risk” if they do not have any of the following2:
Personal history of CRC or certain kinds of polyps;
Family history of CRC;
Confirmed or suspected CRC syndrome, such as Lynch syndrome (hereditary nonpolyposis colon cancer);
Inflammatory bowel disease (Crohn disease or ulcerative colitis); or,
Personal history of receiving radiation to the abdomen or pelvic area for previous cancer treatment.
An individual who does have any of the items listed above may be at increased risk for CRC and may need to start screening before 45 years of age.2
From 76 to 85 years of age, individuals should speak with their doctor and consider factors such as overall health, life expectancy, and screening history.2,3 Beyond 85 years of age, the ACS does not recommend further screening.2
Testing for Colon Cancer With Visual Exams
There are 3 types of visual exams that look at the rectum and large intestine (colon) to screen for cancer.2 Colonoscopy is the gold standard for CRC screening, but, if necessary, your doctor may recommend other methods.
Colonoscopy
During a colonoscopy, a doctor inserts a tube, called a colonoscope, through the rectum and into the colon to search for abnormal growths, such as polyps, along the lining of the intestines. The doctor may also remove polyps during the procedure to prevent them from turning into cancer. The polyps may later be examined in a biopsy to confirm if cancer is present.4,5 A colonoscopy may be performed as a follow-up test to other screening methods.
Frequency: Every 10 years2
CT Colonography (Virtual Colonoscopy)
Computed tomography (CT) colonography, also referred to as “virtual colonoscopy,” uses a series of X-rays to produce computer-generated images of the colon. A doctor will examine the images for signs of precancerous or cancerous polyps. Before the procedure, you will be asked to drink a liquid with a dye that serves as contrast medium to help make the colon visible during radiation.7 In some cases, IV contrast is used instead.6 During the procedure, a doctor will insert a tube into the rectum to inflate the colon with carbon dioxide for better imaging. Then, the doctor performs CT scans to visualize the colon.5-7 A follow-up colonoscopy is necessary if the colonography finds abnormal results.9
Frequency: Every 5 years2
Flexible Sigmoidoscopy
A doctor inserts a tube, called a sigmoidoscope, into the rectum and lower portion of the colon to look for abnormal growths of tissue, such as polyps.5 During the procedure, the doctor may also remove polyps or tissue to later examine for cancer. If precancerous polyps or cancer are detected, you will be asked to schedule a colonoscopy, since a sigmoidoscopy only examines a portion of the colon.8,9
Frequency: Every 5 years2
Testing for Colon Cancer With Stool Tests
Unlike colonoscopy, which can help prevent CRC via precancerous polyp removal, stool tests detect CRC after it has developed. There are 3 types of stool tests, of which 2 detect blood in the stool and the third detects blood in addition to DNA biomarkers for cancer in the stool.9 Stool tests are performed at home but may need to be done more frequently than visual exams.8 For all stool tests, abnormal results require a follow-up colonoscopy visit.9
Guaiac-Based Fecal Occult Blood Test (gFOBT)
The gFOBT uses the chemical guaiac to detect blood in the stool. Before the test, your doctor may ask you to avoid consuming certain foods and drugs, which may affect test results.8,9 You will receive an at-home test kit, which contains tools and instructions on how to collect a small stool sample. Then, you mail the sample back to the doctor or laboratory, where guaiac is used to detect blood in the stool.5,10
Frequency: Every year2
Fecal Immunochemical Test (FIT)
The FIT uses antibodies to detect blood in the stool. You will receive an at-home test kit, which contains a collection tube or cards. You will collect a small stool sample and return it to a doctor’s office or laboratory via mail or in person. At the laboratory, a liquid is added to the stool sample and then processed in a machine containing antibodies, which detect blood in the stool.10
Frequency: Once a year2
FIT-DNA Test
The FIT-DNA test, or “stool DNA test,” uses both the FIT and a test that detects DNA biomarkers, or changes, in the stool from cancer or polyp cells.5,9 Using an at-home test kit, you will collect an entire stool sample and mail it back to a laboratory, where it will be analyzed for DNA alterations and blood in the stool.9,11
Frequency: Every 3 years2
Frequently Asked Patient Questions
Will I experience discomfort during colonoscopy?
Colonoscopy is performed using sedation, so you will likely sleep through the procedure.16 Most patients report discomfort with the process leading up to colonoscopy: bowel preparation. You will be instructed to take laxatives and follow a liquid diet, which will help empty the colon of all waste.4
Why is bowel preparation important for colonoscopy?
Thoroughly cleansing stool from the colon helps the doctor clearly detect precancerous and cancerous tissue, which also decreases the need for repeat colonoscopies. A doctor may choose not to proceed with the procedure due to inadequate bowel preparation, which increases the risk for false-negative results and perforation.4
Besides screening methods, what else can I do to help prevent CRC?
Healthy lifestyle choices can help lower your risk for CRC. Consult with your doctor about the information below:
Diet
Research shows that red meat, such as beef, lamb, or pork, and processed meats, such as sausage, hotdogs, or deli meat, are associated with an increased risk for CRC.12 In contrast, a diet high in fiber, such as fruits, vegetables, and whole grains, is associated with a reduced risk for CRC.13
Exercise
Regular physical activity can be beneficial. Studies show that exercise can help decrease your risk for CRC.14
Weight management
Overweight and obesity are linked to an increased risk for CRC among both men and women.15
A 16-year-old adolescent presents for treatment of a facial breakout. The condition has been increasing in severity over the past year. Her family history is positive for moderate to severe acne and her father was treated with a course of isotretinoin while a college student. She has never taken birth control pills and is on no oral medications. Several weeks ago, she self-medicated with an over-the-counter benzoyl peroxide gel but found the preparation too irritating. Examination reveals multiple 1- to 2-mm whitish papules.
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From beneath a warm swaddling of blankets, Marisa Fine had no way of knowing that her newborn son had a foot deformity. But about 2 weeks after he was born, something looked odd during bath time.
When her son was 1 month old, Marisa and her husband decided to see a clinician to get answers as to why their son’s feet appeared deformed. At their local hospital in Israel, they received a diagnosis for their son: metatarsus adductus (MTA).
Treatment Options for MTA
MTA is a congenital condition that occurs in between 1 and 3 in 1000 births. In infants without MTA, a line that bisects the heel will also bisect the space between the second and third toe. In infants with mild MTA, the line will bisect the third toe; in moderate cases, the line will bisect the space between the third and fourth toe, and in severe cases, the line will bisect the space between the fourth and fifth toe.1
Credit: Courtesy of UNFO Med. Ltd
"
Dr Daizade is hopeful that patients around the world will benefit from access to orthotic devices to treat MTA.
Historically, parents have had 3 treatment options to correct their child’s MTA. Since the condition in many cases self-corrects, parents are often given the option to wait and see if treatment is necessary. If MTA does not self-correct or if parents elect to initiate treatment immediately, then the child can undergo a casting process to straighten their feet or opt for wearing modified shoes or braces.
“I didn’t want to take a gamble on my child's feet or legs,” she said. “If it doesn't correct itself, there could be a problem later on…I wanted to be able to do something. I didn't want to just wait and I didn't want to do casting. I looked into it and it's so painful for the child, it's uncomfortable, and it's not aesthetic… it's just very problematic.”
Not only are novel orthotic devices effective in treating MTA in children aged 10 months or younger,2 they are also more convenient for parents since they are easy to use and resemble an infant shoe, reducing social burden associated with MTA treatment.1
“The remarkable ease and simplicity in treating infants with UNFO orthotic splints introduces a new reality, allowing for the treatment of any type of MTA without age limitations and the risk of lifelong deformities,” said Izak Daizade, MD, a leading expert in orthopedic surgery with more than 30 years of experience dedicated to treating newborns, including Marisa’s son. “The considerable therapeutic success observed in extensive studies further validates this innovative approach. Comparatively, the method of treatment involving a series of casts pales in effectiveness when compared to the treatment with UNFO casts.”
Serial casting is typically completed over a 6 to 8-week span with casts changed every 2 weeks; Dr Daizade explained that this process is burdensome for infants with MTA and their parents.
“Muscles may temporarily weaken, and there may be joint stiffness after ankle and knee fixation,” Dr Daizade said. “Care must be taken to keep the cast dry during bathing, and pressure sores may develop beneath it. Swelling in the foot because of impaired blood flow and hygienic discomfort, especially with long leg casts, are common.”
Unlike casts, orthotic devices used to treat MTA operate below the ankle to allow the joint to move freely, preventing stiffness. Skin complications are less likely to occur in patients who use orthotics vs casts, as parents have the opportunity to monitor the infant’s skin daily during sock changes and bath time.
How to Use Novel Orthotic Devices for MTA
While protocol varies depending on the severity of the infant’s MTA, orthotic devices are meant to be used continuously for 6 to 8 weeks, followed by 6 to 8 weeks of nighttime use on average.3
On the first day of bracing, the device should be removed every 2 hours for 10 minutes; the brace should not be removed on the first night unless the brace causes irritation to the infant.3
The second day should follow the same pattern as the first with removal every 2 hours for 10 minutes; however, the brace can be removed after the infant’s evening bath on the second day. Over the next 12 days, the infant should wear the brace 24 hours a day except for 2 removals: once in the morning, during which the infant’s socks should be changed, and once in the evening for bath time.3
At 2 weeks, a clinician will determine optimal next steps. Typically, a second check-up occurs after 6 weeks of continuous use. At this point, the clinician will determine whether the infant still requires 24-hour therapy, or if the patient can switch to 15-hour overnight therapy. A third check-up should take place after 3 weeks of 15-hour overnight therapy; at this time, the clinician will determine if the patient can switch to 12-hour overnight therapy. After 3 weeks of 12-hour overnight therapy, a fourth check-up should take place to determine if the brace is no longer needed.3
If a parent or clinician observes regression at any point in the process, resumption of 24-hour therapy should be considered.3
Expanding Access to Novel Orthotic Devices
Dr Daizade is hopeful that patients around the world will benefit from access to orthotic devices to treat MTA. So far in the United States, patients in Miami and Baltimore have been successfully treated with the device.
With increased awareness of the condition and noninvasive treatment options available, Marisa hopes that more infants will have positive outcomes like her son.
“These children, they don't need to suffer,” Marisa said. “They don't need to have these uncomfortable casts that can be so traumatizing when they're little and there's a better option out there and it doesn't hurt. It's not invasive and it's easy to use. Why would you have your child go through that if they don't have to?”
Kaiser Health News -- The Biden administration finalized nursing home staffing rules Monday that will require thousands of them to hire more nurses and aides — while giving them years to do so.
The new rules from the Centers for Medicare & Medicaid Services (CMS) are the most substantial changes to federal oversight of the nation’s roughly 15,000 nursing homes in more than 3 decades. But they are less stringent than what patient advocates said was needed to provide high-quality care.
Spurred by disproportionate deaths from COVID-19 in long-term care facilities, the rules aim to address perennially sparse staffing that can be a root cause of missed diagnoses, severe bedsores, and frequent falls.
“For residents, this will mean more staff, which means fewer ER visits potentially, more independence,” Vice President Kamala Harris said while meeting with nursing home workers in La Crosse, Wisconsin. “For families, it’s going to mean peace of mind in terms of your loved one being taken care of.”
"
CMS estimated the rules will ultimately cost $6 billion annually, but the plan omits any more payments from Medicare or Medicaid.
When the regulations are fully enacted, 4 in 5 homes will need to augment their payrolls, CMS estimated. But the new standards are likely to require slight if any improvements for many of the 1.2 million residents in facilities that are already quite close to or meet the minimum levels.
“Historically, this is a big deal, and we’re glad we have now established a floor,” Blanca Castro, California’s long-term care ombudsman, said in an interview. “From here we can go upward, recognizing there will be a lot of complaints about where we are going to get more people to fill these positions.”
The rules primarily address staffing levels for 3 types of nursing home workers. Registered nurses, or RNs, are the most skilled and responsible for guiding overall care and setting treatment plans. Licensed practical nurses, sometimes called licensed vocational nurses, work under the direction of RNs and perform routine medical care such as taking vital signs. Certified nursing assistants are supposed to be the most plentiful and help residents with daily activities like going to the bathroom, getting dressed, and eating.
While the industry has increased wages by 27% since February 2020, homes say they are still struggling to compete against better-paying work for nurses at hospitals and at retail shops and restaurants for aides. On average, nursing home RNs earn $40 an hour, licensed practical nurses make $31 an hour, and nursing assistants are paid $19 an hour, according to the most recent data from the Bureau of Labor Statistics.
CMS estimated the rules will ultimately cost $6 billion annually, but the plan omits any more payments from Medicare or Medicaid, the public insurers that cover most residents’ stays — meaning additional wages would have to come out of owners’ pockets or existing facility budgets.
The American Health Care Association, which represents the nursing home industry, called the regulation “an unreasonable standard” that “creates an impossible task for providers” amid a persistent worker shortage nationwide.
“This unfunded mandate doesn’t magically solve the nursing crisis,” the association’s CEO, Mark Parkinson, said in a statement. Parkinson said the industry will keep pressing Congress to overturn the regulation.
Richard Mollot, executive director of the Long Term Care Community Coalition, a New York City-based advocacy nonprofit, said “it is hard to call this a win for nursing home residents and families” given that the minimum levels were below what studies have found to be ideal.
The plan was welcomed by labor unions that represent nurses — and whom President Joe Biden is counting on for support in his reelection campaign. Service Employees International Union President Mary Kay Henry called it a “long-overdue sea change.” This political bond was underscored by the administration’s decision to have Harris announce the rule with SEIU members in Wisconsin, a swing state.
The new rules supplant the vague federal mandate that has been in place since the 1980s requiring nursing homes to have “sufficient” staffing to meet residents’ needs. In practice, inspectors rarely categorized inadequate staffing as a serious infraction resulting in possible penalties, federal records show.
Starting in 2 years, most homes must provide an average of at least 3.48 hours of daily care per resident. About 6 in 10 nursing homes are already operating at that level, a KFF analysis found.
The rules give homes breathing room before they must comply with more specific requirements. Within 3 years, most nursing homes will need to provide daily RN care of at least 0.55 hours per resident and 2.45 hours from aides.
CMS also mandated that within 2 years an RN must be on duty at all times in case of a patient crisis on weekends or overnight. Currently, CMS requires at least 8 consecutive hours of RN presence each day and a licensed nurse of any level on duty around the clock. An inspector general report found that nearly a 1000 nursing homes didn’t meet those basic requirements.
Nursing homes in rural areas will have longer to staff up. Within 3 years, they must meet the overall staffing numbers and the round-the-clock RN requirement. CMS’ rule said rural homes have four years to achieve the RN and nurse aide thresholds, although there was some confusion within CMS, as its press materials said rural homes would have 5 years.
Under the new rules, the average nursing home, which has around 100 residents, would need to have at least 2 RNs working each day, and at least 10 or 11 nurse aides, the administration said. Homes could meet the overall requirements through 2 more workers, who could be RNs, vocational nurses, or aides.
Homes can get a hardship exemption from the minimums if they are in regions with low populations of nurses or aides and demonstrate good-faith efforts to recruit.
Democrats praised the rules, though some said the administration did not go nearly far enough. Rep. Lloyd Doggett (D-Texas), the ranking member of the House Ways and Means Health Subcommittee, said the changes were “modest improvements” but that “much more is needed to ensure sufficient care and resident safety.” A Republican senator from Nebraska, Deb Fischer, said the rule would “devastate nursing homes across the country and worsen the staffing shortages we are already facing.”
Advocates for nursing home residents have been pressing CMS for years to adopt a higher standard than what it ultimately settled on. A CMS-commissioned study in 2001 found that the quality of care improved with increases of staff up to a level of 4.1 hours per resident per day — nearly a fifth higher than what CMS will require. The consultants CMS hired in preparing its new rules did not incorporate the earlier findings in their evaluation of options.
CMS said the levels it endorsed were more financially feasible for homes, but that assertion didn’t quiet the ongoing battle about how many people are willing to work in homes at current wages and how financially strained homes owners actually are.
“If states do not increase Medicaid payments to nursing homes, facilities are going to close,” said John Bowblis, PhD, an economics professor and research fellow with the Scripps Gerontology Center at Miami University. “There aren’t enough workers and there are shortages everywhere. When you have a 3% to 4% unemployment rate, where are you going to get people to work in nursing homes?”
Researchers, however, have been skeptical that all nursing homes are as broke as the industry claims or as their books show. A study published in March by the National Bureau of Economic Research estimated that 63% of profits were secretly siphoned to owners through inflated rents and other fees paid to other companies owned by the nursing homes’ investors.
Charlene Harrington, a professor emeritus at the nursing school of the University of California-San Francisco, said: “In their unchecked quest for profits, the nursing home industry has created its own problems by not paying adequate wages and benefits and setting heavy nursing workloads that cause neglect and harm to residents and create an unsatisfactory and stressful work environment.”
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.
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