With the downward curve in COVID-19 cases, more and more people are pursuing once-delayed medical treatment. It's a positive trend that University of Michigan Health gastroenterologist Tadd Hiatt, M.D., is happy to see as colorectal screening appointments continue to increase.

It's a good sign, and an important one, he says, noting that approximately 1 in 23 men and 1 in 25 women will be diagnosed with colorectal cancer in their lifetime, according to the American Cancer Society.

Hiatt cautions that while the overall rate of older adults diagnosed with colon or rectal cancer each year has declined, thanks to early screening and lifestyle changes, the rate is going up among younger adults between the ages of 45 and 64, prompting new guidelines.

Hiatt answers five important questions about COVID-19 safety measures, the need for earlier colorectal screenings and whether in-home screening tests are effective.

1. Are COVID-19 safety precautions still in place?

"Despite the decrease in COVID-19 cases, we continue to have safety practices in place here at University of Michigan Health," said Hiatt. "As mask mandates are lifting at schools and other places where people gather, this is not the case in hospitals. Most of the restrictions that were in place during the height of COVID-19 are still in place – and likely will be for a long time."

However, individuals scheduled for a colonoscopy do not need to be vaccinated and no longer need to be tested for COVID-19 prior to their procedure, except in certain circumstances, Hiatt says.

"Patients are still required to wear masks and our team is outfitted with personal protective equipment to ensure safety."

2. Why is it important to keep up with routine screenings?

"We all need to do health care maintenance, despite COVID-19," said Hiatt, noting that colonoscopy is the most effective way to diagnose and treat early-stage polyps and colon/rectal cancer.

"Throughout the pandemic, we've encouraged our patients to avoid pausing their screenings, which can result in delays in colon or rectal cancer diagnosis." This is especially true for individuals with a history of polyps or a family history of colorectal cancer, Hiatt says.

3. What if I put my test off?

"A one-year delay in your procedure may not be a big issue if you have no risk factors, but it could be for patients with a family history of colon cancer or who have had polyps in the past," Hiatt said.

Catching polyps and small cancers early often reduces the need for more aggressive treatments, including surgery, chemotherapy and radiation.

4. What are the latest guidelines?

The American Cancer Society and the American Society of Colon and Rectal Surgeons now recommend adults with no family history of colorectal cancer or other genetic risk factors have their first screening at age 45. Doctors may recommend an earlier age for those with risk factors. Screenings should continue until age 75 and individuals over 75 should consult with their health care provider about whether they need ongoing screenings.

For individuals with a history of polyps, a follow-up procedure is now recommended every 7 years instead of every 5 years, says Hiatt.

"This might be for a person with 1 to 3 polyps that are smaller than 1 centimeter, for example. Someone with more or larger polyps might need to come back in 3 to 5 years. But this all depends on the patient's history and risk factors."

5. Are at-home screening tests for colorectal cancer effective?

"Non-invasive DNA-based home screening tests are fine for low-risk individuals," said Hiatt, but he stresses the need for regular colonoscopies if you have a family history or prior discovery of polyps. "A colonoscopy is much more accurate and thorough than an at-home test," he said. However, for those without risk factors who are still uneasy about COVID-19, "an at-home DNA-based test is better than nothing."

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