It’s not a topic most of us like to talk about — or even think about. Colon cancer screening isn't fun, but it's important for good reason.

Colorectal cancer is the third leading cause of cancer deaths in the United States.  Screening can find cancers early, before they have a chance to grow. Early detection is important because the earlier cancer is found, the more treatable it is. To help fend off its threat, let’s start with some basics.

What does the colon do?

The colon and rectum are part of the gastrointestinal (GI) tract. Located between the small intestine and the rectum, the colon removes water and some nutrients from digested food. The remaining solid waste moves through the colon, and is stored in the rectum until it leaves the body through the anus. 

What is colon cancer?

Small growths, called polyps, often form along the colon lining. Some types of polyps can become cancerous. Until it grows or spreads, colon cancer often has no symptoms. That’s why early detection is one of the best ways to fight the disease. 

Don't skip screening.

Today, there are options that make colon cancer screening easier. Talk about them with your health care provider. Each has advantages and drawbacks. The test you choose may depend on your family history, your past medical history and your current health.  Options include:

Guaiac-based Occult Blood Test: A stool sample is collected by the patient, sent to the lab and tested for blood. The test doesn’t require colon prep or fasting. It’s not invasive and is typically done once every year.

Fecal Immunochemical Test (FIT): A stool sample is collected by the patient, sent to the lab and tested for blood. It’s usually done once a year. Compared to guaiac-based occult blood testing, FIT is a more sensitive when it comes to detecting blood. The test doesn’t require any prep or fasting and isn’t invasive.

FIT-DNA or FIT sDNA: This screening uses FIT testing along with a test that detects the DNA in colorectal cancer. A prescription is needed for the screening. Once ordered, the testing company mails a screening kit to the individual’s home so  they can collect a stool sample and mail it back. The test does not require colon prep and is non-invasive. This screening is recommended every three years.

Flexible sigmoidoscopy: A doctor uses a small camera to look inside the rectum and the last one-third of the colon. It’s an invasive test that can be done in the office without sedation. It’s usually repeated every five years.

Colonoscopy: A doctor uses a small camera to look inside the rectum, colon and the last part of the small intestine. It’s an invasive test performed once every 10 years in people of average risk.

As one of the most common forms of screening, colonoscopy is also one of the most dreaded due to the colon prep. Keep in mind, the prep is meant to help you stay healthy! If you and your doctor decide a colonoscopy is best for you, you’ll get prep instructions to follow at home.  

The next day, your doctor will use a colonoscope — a long, narrow, flexible tube with a light and tiny camera on one end — to look for any abnormal areas in your rectum and colon.  Your doctor will take a sample (biopsy) or remove any abnormal tissue, like polyps. Your doctor or anesthesiologist will give you medicine to make you comfortable. Most colonoscopies can be done as a day procedure, but you’ll need someone to drive you home.

How often is screening recommended?

Your doctor will let you know how often you should be tested based on your risks, prior history of cancer or polyps and the test you choose. Some of the risk factors include:

1. Age: The number of people with colorectal cancer between ages 40 to 49 is growing. Screening should start at age 45 (or earlier if you have other risk factors).
2. Race: Colorectal cancers occur more often in Black Americans, Native Americans and Alaskan Native individuals.
3. Hereditary syndromes: These are conditions that are passed down in families.
4. History of colon cancer or polyps that can turn into cancer: If you have a history of colon cancer or certain types of polyps, your doctor may recommend more frequent screening.
5. Inflammatory bowel disease: People with Crohn’s or Ulcerative Colitis are at increased risk of colorectal cancer.
6. Radiation therapy: People with a personal history of radiation therapy to the abdomen or pelvis are at increased risk of colorectal cancer.
7. Cystic fibrosis: People with cystic fibrosis have an increased risk of colorectal cancer.

No symptoms, no worries, right?

Wrong. Remember, early detection screening is designed to find cancer before symptoms develop. Still, call your doctor if you have any of these warning signs:

• Change in bowel habits
• Rectal bleeding or bloody stools
• Abdominal pain
• Anemia
• Unexplained weight loss

Make the most of your health care benefits.

Once you find a doctor you want to see, call to verify the provider is in-network. Have your insurance ID card handy to help the office staff determine if they are in network.

If you are a Medicare Advantage member, you may be eligible to earn a health reward when you get a colorectal screening. Learn more about health rewards and see if you are eligible.

Sources: Colorectal Cancer Statistics,  Centers for Disease Control and Prevention, 2024; Colorectal Cancer,  American Cancer Society; Epidemiology and Risk Factors for Colorectal Cancer,  UpToDate, 2024; Test for Screening for Colorectal Cancer,  UpToDate, 2024; Clinical Presentation, Diagnosis, and Staging of Colorectal Cancer,  UpToDate, 2024

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Originally published 10/27/2016; Revised 2019, 2021, 2022, 2024