Prevention (polyp removal	->	decreased incidence
Early detection	->	decreased mortality

The risk of colorectal cancer increases sharply with age, and 90 percent of colorectal cancer cases occur in people over 50. As a result, regular colorectal cancer screening is strongly recommended for persons 50 years of age and older. The Centers for Disease Control and Prevention (CDC) estimate that more than one-third of all colorectal cancer deaths could be prevented by regular screening.

Table 15
Centers For Disease Control And Prevention
Colorectal Cancer Screening Options For People Over 50*

TEST TYPE	PERIODICITY	BENEFITS	SHORTCOMINGS
FOBT+	Every Year	33% mortality reduction	Performed at home and subject to patient error; test not specific for colorectal cancers
Flex Sig#	5 years	60% mortality reduction from distal colon/rectal cancers.	No reduction in deaths from proximal colon cancers.
Colonoscopy	10 years	66% reduction of new cancers. Most accurate test for detecting polyps.	Not recommended for patients with advanced age.
DCBE++	5-10 years	Provides view of the entire colon.	Lower sensitivity to detecting polyps than colonoscopy.

*From A Call to Action: Prevention and Early Detection of Colorectal Cancer (CRC). Centers for Disease Control and Prevention. U.S. Department of Health and Human Services, 2000.
+Fecal occult blood test
#Flexible Sigmoidoscopy
++Double contrast barium enema

According to the American Cancer Society (ACS) guidelines for screening, men and women over the age of 50 should follow one of the following screening options:

• Yearly fecal occult blood test (FOBT) + flexible sigmoidoscopy every 5 years, or
  
• Colonoscopy every 10 years, or
  
• Double contrast barium enema every 5-10 years.

A digital rectal examination (DRE) should also be performed at the time of each sigmoidoscopy, colonoscopy, or barium enema examination.

For individuals exhibiting any of the following colorectal cancer risk factors, screening should begin at an earlier age and be performed more often:

• A strong family history of colorectal cancer or polyps (cancer or polyps in a first degree relative younger than 60 or in two first-degree relatives of any age); or
  
• A family with hereditary colorectal cancer syndromes (familial adenomatous polyposis and hereditary non-polyposis colon cancer); or
  
• A personal history of colorectal cancer or adenomatous polyps; or
  
• A personal history of chronic inflammatory bowel disease.

New Jersey Cancer Education and Early Detection Screening Services (NJCEED)

The New Jersey Cancer Education and Early Detection Services (NJCEED), New Jersey Department of Health and Senior Services, provides free screening for colorectal cancer, as well as breast, cervical, and prostate cancers, for uninsured or low-income individuals over the age of 40. NJCEED contracts with an agency in 20 of New Jersey's 21 counties to provide these services. The phone number of the program office in each county are listed below: