Colorectal cancer (CRC) is one of the most common cancers in the United States and is the second leading cause of cancer-related deaths. CRC may be detected with regular screening. Screening tests are important because they can help prevent CRC by detecting precancerous growths (known as polyps) in the colon or rectum or help detect the cancer early when it’s small and hasn’t spread. When CRC is detected early, it can be easily treated.
The American Cancer Society and other organizations have developed screening guidelines for people at average and high risk for colorectal cancer. Men and women who are 45 years of age and older should be regularly screened for colorectal cancer. Some individuals with higher risk need to be tested at an earlier age. According to the American Cancer Society, individuals who have certain intestinal diseases (ulcerative colitis and Crohn’s disease), inheritable colon cancer syndromes (familial adenomatous polyposis and Lynch syndrome) are at high risk of colorectal cancer and should begin screening at even younger age.
There are several test options available for people at average risk for CRC. This page provides education materials on CRC screening developed as part of the larger multi-level Colorectal Cancer Screening Projects which have been funded by the Cancer Prevention Institute of Texas (CPRIT) since 2010. These patient educational materials have been developed in collaboration with the clinical partners from the Community Network for Cancer Prevention and are utilized by the project’s clinical collaborators, Harris Health System, San Jose Clinic, Tomagwa Healthcare Ministries and other community clinics, as part of their cancer prevention efforts.
Selected Colorectal Cancer Screening Tests
Fecal Occult Blood Test (FOBT)
The fecal occult blood test, also known as FOBT, screens for small amounts of blood in a patient’s stool sample. This test can be done at home and patients are asked to follow a special diet and avoid taking certain drugs that may affect the test results. If blood is found in the stool, additional exams, such as a colonoscopy, may be necessary, since the presence of blood can be a sign of colon cancer.
When to Have the FOBT?
FOBT is a screening test that is done every year. When performed annually FOBT allows physicians to track patients at high risk for CRC.
For more information about the CRC screening test FOBT, visit the American Cancer Society website.
FOBT Educational Materials
The FOBT education materials in use by some of the CRC Screening Project’s clinical partners include the FOBT Educational Videos and printed patient instruction guides.
FOBT Educational Videos
During their clinic visit, patients eligible for CRC screening can view a brief educational video about CRC screening in English or Spanish before speaking with their physician.
Each video is culturally and linguistically appropriate for Black or African American, non-Hispanic White, and Hispanic men and women. Because the nursing staff documents video views, reports may be used to analyze whether CRC screening rates improve, and whether patient’s knowledge and attitudes change about CRC screening
The FOBT Educational videos can be viewed in the Online Health Library under the “Colorectal Cancer” tab.
Printed Instruction Guide for FOBT
This printed guide is a set of easy-to-read step-by-step instructions for the FOBT. The guide is designed to help patients complete their FOBT screening in the privacy of their homes. It explains how to perform the test, how to properly store the specimens, and where to return them.
At the end of the clinic visit, a clinical team member explains the instructional guide to the patient and provides a printed copy.
View the guide in English or Spanish.
Fecal Immunochemical Test (FIT)
The fecal immunochemical test, also known as FIT, is another screening test for CRC. Like the FOBT, the FIT detects small amounts of blood in feces, which might be a sign of a polyp or cancer. FIT is performed the same way as the traditional FOBT, which can be done from home. The FIT test does not require following a special diet or using special drugs to prepare for the test. If blood is found in the stool, additional exams, such as a colonoscopy, may be necessary, since the presence of blood can be a sign of colon cancer.
When to Have the FIT?
The FIT is performed annually, beginning at age 45. The FIT allows physicians to track patients at high risk for CRC.
For more information about the CRC screening test FIT, visit the American Cancer Society website.
I-FIT Kit and Educational Materials
Current FIT materials used by our clinical partners in our CPRIT-funded project is the i-FIT kit – which includes a distribution bag provided to patients with materials for stool collection and resources to assist them in doing the test at home. The resources provided are printed patient instructions, educational videos, and a telephone hotline to hear the content of the printed instruction forms.
I-FIT Kit
The multilingual i-FIT kits (English, Spanish, Vietnamese) are provided to patients at Harris Health System at the point of care and contain printed patient instructions for collecting the stool sample, a sample collection bottle, and a biohazard bag. These materials are included in a biodegradable distribution bag developed for individual patients to carry all of their sample collection supplies discreetly, including a reminder to take the test and information for returning the sample. The purpose of the i-FIT kit is to:
- Increase knowledge and awareness of CRC screening guidelines and services among Harris Health System patients.
- Provide tools to health providers to educate patients about CRC screening resources available at the state, regional, and local levels.
- Increase rates of referral and follow-up of abnormal i-FIT results through the Harris Health System.
- Increase the proportion of patients identified as being at risk for CRC.
- Increase the proportion of patients diagnosed with CRC in precancerous or early stages of the disease
I-FIT Educational Videos
Eligible patients (due or past due for CRC screening) in the Harris Health System are identified by the nursing staff during patient intake through the Epic system health-maintenance module in the patient’s electronic medical record system. The nurse asks eligible patients to select and view a brief educational video about CRC screening in English, Spanish, or Vietnamese before their encounter with their physician.
Each video is culturally and linguistically appropriate for Black or African-Americans, non-Hispanic Whites, Hispanics, and Vietnamese men and women. Because the nursing staff document video views, reports may be used to analyze CRC screening rates, and whether patient’s knowledge and attitudes about CRC screening change.
The i-FIT educational videos can be viewed online on the Online Health Library under the “Colorectal Cancer” tab.
Printed Instruction Guide for i-FIT
At the end of the clinic visit, a Harris Health System staff member explains this instructional guide to the patient. This printed guide is a set of easy-to-read step-by-step instructions for the i-FIT in English, Spanish and Vietnamese. It explains how to perform the test, how to properly store the specimens, and where to return them. The guide is designed to help patients complete their i-FIT screening in the privacy of their homes.
View the guide in English, Spanish, and Vietnamese.
Colonoscopy
A colonoscopy is a screening test that uses a scope to examine the inside of the entire colon and rectum for abnormal growths (polyps). This test is more sensitive and accurate than the FOBT and FIT. This procedure requires that patients follow dietary and medication restrictions to be accurate. Patients are also asked to drink a liquid solution to clean and empty their colon before their procedure. The test aims to find and remove precancerous polyps before they develop into colorectal cancer.
Who Should Have a Colonoscopy?
Based on the recommendations of the American Cancer Society:
Men and women 45 years of age and older who are at average risk of colorectal cancer should have a colonoscopy once every 10 years. Men and women with a family history of colorectal cancer should first be screened at age 40 (or at an age that is 10 years younger than the age at which the youngest immediate family member was diagnosed with the disease) and should be screened once every 5 years.
Individuals who have certain intestinal diseases (ulcerative colitis and Crohn’s disease), inheritable colon cancer syndromes (familial adenomatous polyposis and Lynch syndrome) are at high risk of colorectal cancer and should begin screening at even younger age.
Men and women who have had polyps or other precancerous tissues removed and those who have had CRC should only be screened with a colonoscopy.
In the Harris Health System, when patients have a positive FIT result or present to the clinic with symptoms suspicious of for colon cancer, they are referred to a gastroenterologist for a colonoscopy.
Colonoscopy Educational Materials
To help patients understand how to prepare for the procedure properly, the Community Network for Cancer Prevention in collaboration with the clinical staff of the Harris Health System, developed colonoscopy preparation videos and colonoscopy instruction printed guides.
Preparing for a Colonoscopy Educational Videos
Patients referred to a gastroenterologist for a colonoscopy can view a brief educational video about preparing for a colonoscopy. The videos are designed to help patients properly prepare for a colonoscopy and they are complementary to the printed patient information instructions provided to them in preparation for the procedure. Each video is culturally and linguistically appropriate for Black or African-Americans, non-Hispanic Whites, Hispanics, and Vietnamese men and women. Patients in the Harris Health System may be prescribed either the Golytely or MoviPrep solutions to empty and clean their colon before the colonoscopy procedure. Patients may access the instructional videos in English, Spanish, or Vietnamese, which describe the steps to prepare for the procedure using the Golytely or MoviPrep solutions.
The videos include detailed instructions on how to prepare the solutions, when and how often to drink them, dietary and drug restrictions, and the timing for special medications before the test. Additionally, the video includes information about what to expect during the procedure, the duration, and any physical restrictions afterward.
The preparation for a colonoscopy videos using Golytely and MoviPrep are found in the Online Health Library under the “Colorectal Cancer” tab.
Printed Instruction Guide for Colonoscopy Preparation
The printed colonoscopy preparation instructional guides are a set of easy-to-read instruction sheets given to Harris Health System patients, specific to the solution (Golytely or MoviPrep). The instruction guide indicates when they are scheduled to undergo the colonoscopy, step-by-step instructions on how to prepare the solution, when and how often to drink them, dietary and drug restrictions, and timing for special medications before the test. Additionally, the instruction guide includes links to the educational videos, a telephone hotline to hear the content of the printed instruction guide, and important post-procedure information.
The instruction guides are available for patients in English, Spanish, and Vietnamese.
View the Golytely guide in English, Spanish, and Vietnamese.
View the MoviPrep guide in English, Spanish, and Vietnamese.
For more information about colonoscopies or other colorectal cancer screening exams, visit the American Cancer Society website.
References
American Cancer Society. (2024a, January 29). Colorectal Cancer Guideline | How Often to Have Screening Tests. https://www.cancer.org/cancer/types/colon-rectal-cancer/detection-diagnosis-staging/acs-recommendations.html
American Cancer Society. (2024b, February 16). Colonoscopy. https://www.cancer.org/cancer/diagnosis-staging/tests/endoscopy/colonoscopy.html
American Cancer Society. (2024c, March 4). Colorectal Cancer Screening Tests | Sigmoidoscopy & Colonoscopy. https://www.cancer.org/cancer/types/colon-rectal-cancer/detection-diagnosis-staging/screening-tests-used.html
Centers for Disease Control and Prevention. U.S. Cancer Statistics Colorectal Cancer Stat Bite. U.S. Department of Health and Human Services; 2024.
