Today’s Katie Couric lost her husband, Jay Monahan, to colon cancer in 1998, and ever since then, she has been determined to make sure that other families don’t have to experience the same loss. Calling colon cancer “an equal opportunity killer,” Couric has been relentless in her advocacy for early screening. Each year, more than 70,000 Americans are diagnosed with colorectal cancer—or cancer of the colon or rectum—and nearly as many women as men die from the disease, which is the No. 2 cancer killer, trailing only lung cancer.

Compounding the problem is the fact that one in four women ages 50 and older who receive a lab slip for colon cancer screening fail to follow through, national health statistics demonstrate. Yet colon cancer has more than a 90% survival rate if treated early. With current screening tools and genetic testing, you might be able to remain colon cancer free for life. In the oft-repeated words of Couric: “You might look and feel fine, but you need to get the inside story. Colorectal cancer often has no symptoms, so please get tested. I did.”

Age 50 is typically the age at which colon cancer screening should begin. If you have a family history, screening should begin earlier. Emphasizing the importance of family history, U.S. Surgeon General Richard H. Carmona says, “Even with all the high-tech tests, medicines, and procedures available in today’s modern health-care setting, family health history remains the cornerstone of our efforts to prevent disease and promote personal health. Knowing your family history can save your life.” And if you know colon cancer is more likely to occur, it will give you the opportunity to undergo screening and stop the development. Colonoscopy is an effective screening and prevention tool.

For families at risk, genetic testing is available for colon cancer assessment. This means that family members with the greatest risk for colon cancer can be identified, as well as those not at high risk, long before cancer begins. Armed with this knowledge, families will be able to determine who should get screened early and who can wait until they are 50. A genetic counselor can guide families through the risks and benefits of testing, particularly understanding and developing a cancer-risk-management plan for the long- term. If the risk of cancer is high, a cancer counselor can help you learn when early screening should begin and how often it should be repeated. Options such as chemoprevention can also be discussed, if necessary.


If genetic testing is appropriate, an expert will help you identify the best person in the family to start with. Testing always begins with a person who has a history of cancer. An unaffected person will be the first person tested only when no family member with a history of cancer is available for genetic evaluation. Sometimes even the colon cancer itself is evaluated for certain markers, before genetic blood testing is started. The first person undergoing testing will have the most expensive test in the family. Once an alteration in a gene is identified, testing close family members is much easier and less costly. Genetic testing is typically covered by insurance. Cancer-risk evaluation and regular screenings are the most important things you can do to stay cancer-free.

• Has a family member been diagnosed with colorectal cancer before age 50?
• Do you have multiple family members on one side of your family with colon, rectal, or uterine (endometrial) cancer?
• Has a family member had colorectal cancer more than once?
• Has someone younger than 65 in your family been diagnosed with uterine cancer, especially if there is also colon cancer in your family?
• Do ovarian, kidney, ureter, stomach, gallbladder, or other tumors run in your family?
• Have you or a family member had 10 or more polyps found over a lifetime from cancer screening?

Colon cancer can be prevented by removing precancerous growths that develop years before symptoms appear. The CDC recommends four screenings:

• Fecal occult blood test (FOBT): Checks for blood in three consecutive stool samples. FOBT reduces colon-cancer deaths by 33% and curbs cancer development by as much as 20% in people who get screened.
• Flexible sigmoidoscopy: A sigmoidoscope (a flexible, lighted tube) is used to visually inspect the interior walls of the rectum and part of the colon. Deaths from cancers located within the sigmoidoscope’s reach can be reduced by as much as 79%.
• Colonoscopy: Similar to sigmoidoscopy, a colonoscope is used to examine interior walls of the rectum and entire colon. Tissue samples can be taken and polyps removed. Colonoscopy is used when other screening tests are positive.
• Double-contrast barium enema: A series of X-rays of the colon and rectum, taken just after an enema containing barium dye followed by an air injection in the lower bowel.

About the Author: Amy Strauss Tranin, ARNP, MS, is a certified cancer-risk and genetic counselor for the Kansas City Cancer Centers in the greater Kansas City metro area.