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Colorectal cancer (CRC) is the third most common cancer in men and the second most common in women globally. It accounts for nearly 10% of annual global cancer incidence. CRC remains the second leading cause of cancer death in the United States.

Screening is crucial for early detection and especially for prevention. The purpose is to detect and remove precancerous lesions, thereby reducing both the incidence and mortality of CRC. Early detection significantly improves survival rates, with a 5-year survival rate of 91% for localized disease compared to 14% for metastatic disease.

Due to this the U.S. Preventive Services Task Force (USPSTF) and the American Cancer Society (ACS) recommend that screening should begin at age 45 for individuals at average risk for colorectal cancer.

Increased-risk individuals, such as those with a family history of colorectal cancer or advanced adenomas, should begin screening earlier, typically at age 40 or 10 years before the earliest diagnosis in the family.

People should be aware of the symptoms of colon cancer as there has been an increase in colon cancer incidence in the younger population, even those below 45.

Recognizing these symptoms that may present in younger individuals is crucial for early detection and timely intervention. The most common symptoms in younger patients with early-onset CRC include rectal bleeding (hematochezia), abdominal or pelvic pain and bloating, and changes in bowel habits. Additional symptoms include iron deficiency anemia, diarrhea, unexplained weight loss.

The presence of these symptoms, especially when multiple symptoms are present, should prompt further diagnostic evaluation, including colonoscopy, to rule out CRC. Early recognition and intervention are essential as younger patients often present with more advanced stages of the disease.

Despite the availability of effective screening methods, participation rates remain suboptimal, often below 40% in many settings. Barriers to screening include lack of awareness, logistical challenges, and concerns about the screening process. Addressing these barriers through education can significantly improve adherence to screening recommendations.

Colonoscopy remains the gold standard for prevention of colon cancer as it can identify and remove polyps to prevent them from progressing towards cancer.

The American College of Physicians (ACP) recommends that clinicians performing colonoscopies should have adequate training and experience to ensure the procedure's safety and effectiveness.

The U.S. Multi-Society Task Force on Colorectal Cancer, which includes the American College of Gastroenterology, the American Gastroenterological Association, and the American Society for Gastrointestinal Endoscopy, emphasizes that the quality of the colonoscopy is crucial. This includes the endoscopist's adenoma detection rate (ADR), which is a key quality indicator associated with reduced colorectal cancer incidence and mortality. Having a gastroenterologist that has been extensively trained to do colonoscopies increases the effectiveness of prevention of CRC.

Early detection through regular screening can save lives. The gold standard for prevention of colon cancer is a colonoscopy.