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How should I be screened for colon cancer?
Women's health
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Tens of thousand of Americans are diagnosed with colorectal cancer (or colon cancer) each year. Women and men are equally affected by this slow-growing cancer that targets the cells in the colon and rectum. It starts when polyps-often benign growths that develop in the colon-turn cancerous.  
While the cause of colon cancer is unknown, age is a factor that increases risk, with approximately 90 percent of colorectal cancers occurring in people older than 50. Women are also at increased risk if they have a first-degree relative younger than 60 (or two or more first-degree relatives of any age) with colorectal cancer or polyps; have had colorectal cancer or polyps themselves; have had bowel disease, such as chronic ulcerative colitis, inflammatory bowel disease or Crohn’s disease; or have a family history of certain types of colon problems or colon cancer.
Colorectal cancer deaths decreased by more than 2 percent from 2002 to 2004, likely due to an increase in screening rates. Unfortunately, only about 50 percent of women are screened according to the most current guidelines.  
ACOG recommends that  all women should be screened for colorectal cancer at age 50-or earlier for African American women and those with high-risk factors-using one of five methods.
According to ACOG, colonoscopy is the preferred method for colorectal cancer screening because it allows for better visualization of the whole colon surface. The physician uses a lighted instrument called a colonoscope to examine the entire colon and rectum. Patients are sedated for the procedure, which generally lasts 20 to 30 minutes. Any pre-cancerous polyps that are found can be removed during the examination. Women should plan to have a colonoscopy once every 10 years.
Women may choose to have a fecal occult blood test or fecal immunochemical test. Stool samples are taken at home for several days and then returned to a lab to be checked for hidden blood. They must be performed annually. Your doctor may also recommend flexible sigmoidoscopy every five years in addition to the annual FOBT or FIT.
Flexible sigmoidoscopy uses a lighted flexible tube to examine the lower colon. Polyps can sometimes be removed during flexible sigmoidoscopy. Sedation may or may not be necessary. Women who choose this procedure should have it every five years.
Women can also be screened using a double contrast barium enema. Patients are given an enema using contrast dye. X-rays of the colon and rectum are then taken. Women should have this exam once every five years.   
Proper screening can help prevent colon cancer. Get screened using the method that you are most comfortable with and most likely to complete.

Noller is president of the American College of Obstetricians and Gynecologists
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