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Daniel Stein, PA-C

When the COVID-19 pandemic hit, non-urgent medical care took a back seat to prioritize more pressing needs and reduce the risk of spreading the virus. Now, almost a year later, an awful lot of people have fallen behind on cancer screenings, perhaps unaware of test options and how health centers have adjusted to maintain safety during the pandemic.

I know some of my patients have been thinking: “I’ll just wait until the pandemic is over.” The thing is, we’re still in the middle of this struggle with the coronavirus and it will be a long time before things return to business as usual.

Meanwhile, cancer screening remains vitally important. I’ve seen patients diagnosed with cancers that potentially could have been caught earlier had the pandemic not interfered with timely screening. If you’re due for a screening or missed an appointment, now is a good time to check in with your health care team about catching up.

There are several cancer screenings to have on your radar: breast, cervical, colon and lung. For colorectal cancer there is a screening test you can complete at home if you are at average risk for colon cancer. The fecal immunochemical test, or FIT test, can identify hidden blood in the stool, which can be an early sign of colon cancer. It’s the test we at Oregon Health & Science University recommend first for average risk adults. Using the supplied test kit, you simply collect a tiny sample, seal it in a container and return it by mail.

For people at higher risk for colorectal cancer, colonoscopy remains the preferred option. This and other in-office cancer screening tests can be done safely during the pandemic. Precautions include masks for everyone, safe distancing in waiting rooms, and COVID testing before procedures.

By age 50, everyone should be getting screened for colorectal cancer. Some authorities recommend starting at age 45, particularly for Black adults who are more likely to die of this disease.

Your risk is above average if you have a family history of colorectal cancer, a personal history of ulcerative colitis or Crohn’s disease, or previous radiation treatment to the stomach or pelvic area. Inherited conditions including familial adenomatous polyposis (FAP) or Lynch syndrome can put people at higher risk.

Your provider can go over risk factors to help you pick the most appropriate screening strategy. If you go with the FIT screening test, it’s important to repeat the screening every year.

If you go with colonoscopy screening, the interval is once every 10 years, as long as findings are negative; more often if pre-cancerous growths called polyps are found. In a colonoscopy, a provider views the interior of the colon with a video camera on the end of long, flexible tube. During the procedure, the provider can remove pre-cancerous polyps. Colonoscopy is also the follow-up step if you have a FIT test that comes back positive.

Colorectal cancer is one of the most preventable cancers. Screening has contributed to a steady decline in the incidence since the mid-1980s. Screening makes it possible to detect not only early-stage cancers but also precancerous lesions, which, when removed, may prevent tumors from developing.

Still, colorectal cancer remains the third most common cause of cancer death among men and women in the U.S., in part because of lapses in the provision of effective screening programs to all Americans. March is National Colorectal Cancer Awareness Month. Why not make a commitment to help get screening for this cancer on track?


Daniel Stein, PA-C is a physician assistant with a special clinical interest in providing health care for underserved populations. He is an assistant professor of family medicine in the Oregon Health & Science University School of Medicine.

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