On November 19, President Joe Biden temporarily transferred presidential power to Vice President Kamala Harris for an important reason: a routine colonoscopy. During the procedure, doctors found and removed a 3 millimeter-sized growth from his colon that appeared to be benign. “The polyp was removed without difficulty,” his doctor’s initial report said. Several days later, on November 23, a follow-up memo said the growth was a tubular adenoma, a “benign, slow-growing, but thought to be potentially pre-cancerous lesion for which no further action is required at this time.” It’s not the first time President Biden has gotten that news. During a 2008 colonoscopy, President Biden had another tubular adenoma removed.
Tubular adenomas are a kind of colon polyp associated with an increased risk of colorectal cancer, according to the Mayo Clinic. Colorectal cancer is the fourth most common and fourth most deadly cancer in the United States, per the Centers for Disease Control and Prevention (CDC).
Most of the time, colorectal cancer begins as a polyp, according to the Mayo Clinic. Colon polyps are cells that clump together along the colon. Polyps are usually harmless, but some can develop into colorectal cancer over time. Anybody can get colon polyps, though people are at higher risk if they’re 50 or older, smoke, have inflammatory bowel diseases like ulcerative colitis or Crohn’s disease, or have a family history of colon polyps or colorectal cancer, among other factors. (There’s a racial disparity when it comes to colorectal cancer specifically; for a complex list of reasons, Black people are more likely to develop and die from the illness.)
Colon polyps can cause rectal bleeding, changes in the color of your poop (including blood in your stool), changes in bowel habits, abdominal pain, or anemia—but these kinds of issues don’t happen very often in relation to colon polyps. Most people actually won’t know they have polyps because they rarely cause symptoms. Instead, screening tools like colonoscopies are used.
Due to increasing rates of colorectal cancer in younger people, the U.S. Preventive Services Task Force (USPSTF) recommends that any adult with an average colorectal cancer risk begins getting routine colonoscopies at 45 (as opposed to the previous recommendation of age 50). A colonoscopy involves a long, flexible tube being inserted into the rectum and snaked through the colon, the Mayo Clinic explains. A small camera on the end allows a doctor to look around, and the tube also allows them to remove and test concerning growths. If you’re getting a colonoscopy, to prep for the procedure, you’ll be instructed to avoid certain foods as well as take a laxative to give your doctor the cleanest view. On the day of, you’ll typically be provided a sedative to help you relax. It usually takes about 30 to 60 minutes for a doctor to complete a colonoscopy.
A virtual colonoscopy requires the same prep work as a standard colonoscopy but uses a CT scan to look for issues instead of an internal exam. But if a polyp is found during a virtual colonoscopy, you’ll have to go through prep work again and have a standard colonoscopy to get the growth removed and tested.
There are other screening tools for colon polyps and colorectal cancer, like flexible sigmoidoscopy, which also uses a small light and camera on a flexible tube, but only examines the last third of the colon. Doctors can’t see any polyps or cancers further into the colon using this technique, the Mayo Clinic notes. There are also stool tests, which look for evidence of blood or polyps in your poop. If a stool test comes back positive, you’ll need to have a colonoscopy for further evaluation.
For people like President Biden who have polyps removed, follow-up screenings are recommended based on how many polyps are found, what size they are, and what their other potential risk factor characteristics look like. Standard screening for one to two polyps is at least every five to 10 years, with the frequency increasing based on the number of polyps involved.