Why Is Colon Cancer Screening Important?

You likely know someone who has delayed their colonoscopy (or perhaps this is you). Many people have postponed cancer screening during the COVID-19 pandemic. But colorectal (or colon) cancer screening is important. Colorectal cancer is the third most common cancer in the U.S., and rates are increasing in younger people. The earlier colorectal cancer is detected, the better the chances for successful treatment. 

Although a colonoscopy is a well-known screening tool, there are several other options available. Read on to learn more about your screening options — and what might be the best choice for you.

Who should be screened for colorectal cancer?

The U.S. Preventive Services Task Force (USPSTF) and the American Cancer Society recommend that adults between age 45 and 75 be screened for colorectal cancer. Previously, the recommendation was to start at age 50. But because more young people are being diagnosed with colon cancer, now the recommendation is to start earlier — at age 45. 

After the age of 75, it’s important to have a discussion with your healthcare provider about the risks and benefits of screening. As you get older, the risks of screening increase.

Screening for people at higher risk of colon cancer

Importantly, these guidelines do not apply if you’re at high risk of colorectal cancer. When you have increased risk of colorectal cancer, you may need to start screening even earlier. For example, if a family member was diagnosed with colorectal cancer at a young age, or if you have inflammatory bowel disease, your screening recommendations will be different. It’s important to discuss your family and medical history with your healthcare provider. 

What are the benefits of screening?

The main benefit of screening is that it helps identify cancers earlier, improves chances of cure, and lowers your risk of dying of colorectal cancer. Screening can identify cancers that aren’t causing symptoms yet. Also, screening tests often identify growths (polyps) that could turn into cancer. If colorectal cancer is caught early, it’s more likely to be successfully treated.

What are the risks of colon cancer screening? 

Every cancer screening test also has some downsides, limitations, or risks, and it’s important to be aware of these. For example:

• The screening test might not find small cancers or precancerous areas. 

• The screening test can be time consuming. You may need to do some preparation, such as dietary changes or cleansing of the bowels. And you may need to take time off work (such as for a colonoscopy).

• There may be complications from the screening procedure, such as pain or bleeding.

• The screening test may find abnormalities that need further evaluation or treatment. This can lead to stress and anxiety as well as additional medical interventions.

What are the options for colon cancer screening?

There are different options for colorectal cancer screening, and it’s a good idea to discuss with your healthcare provider the best option for you. Screening options include: 

• Fecal immunochemical test (FIT) or fecal occult blood tests: These are stool tests that identify blood in the stool.

• Stool DNA test: This is when you provide a sample of your stool to look for DNA changes or blood, which could be signs of cancer. 

• Flexible sigmoidoscopy: This is similar to a colonoscopy, although it doesn’t evaluate the entire colon. It’s faster than a colonoscopy, and usually you don’t need to take sedation medication.  

• Virtual colonoscopy (or CT colonography): This is when a CT scan takes many images of your colon to see if there are any abnormalities in the colon or rectum.

• Colonoscopy: This is when a long, flexible tube with a camera is inserted into your rectum to look at the entire colon. This requires cleansing the bowels and sedation during the procedure. Abnormal tissues (polyps) can be removed during a colonoscopy. 

A colonoscopy is the most thorough screening test, but it isn’t always the best choice for a variety of reasons. It’s important to know that if one of the alternate screening tests is abnormal, then a colonoscopy will be needed.

When should I get screened, and how often should I do it?

If you are between 45 and 75 years of age, you should be doing colon cancer screening. It’s best to talk with your healthcare provider about your overall risk and the right screening options for you. 

There are different options for colorectal cancer screening, and the best test for you will depend on many factors — including your personal risk level, preference, and insurance coverage.

How often you get screened will depend on which screening test you choose. In a typical person, that might be a:

• Colonoscopy every 10 years

• Stool DNA test every 1 to 3 years

• Fecal immunochemical test (FIT) or fecal occult blood test yearly

• Virtual colonoscopy every 5 years

• Flexible sigmoidoscopy every 5 years

Over the age of 75, screening recommendations may change. Some people won’t need screening. For others, the benefits may still outweigh the risks, and screening could still be recommended.

Does my insurance cover colon cancer screening?

Colorectal cancer screening is preventive, and they’re part of required coverage for health plans. But your insurance might not cover every type of screening option. For example, Medicare and some insurance companies will not pay for a virtual colonoscopy. It’s a good idea to review your options with your insurance and healthcare provider, and be sure to ask what the out-of-pocket costs may be for you. 

If you do not have health insurance, there may be some free screening programs available in your community.

Why trust our experts?

Written by:

Christina Palmer, MD

Christina Palmer, MD, is a board-certified family physician with a focus on chronic care management, women’s health, and mental health. She’s the co-author of “Open Heart: When Open-Heart Surgery Becomes Your Best Option.”.

Edited by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. A pulmonologist and hospitalist, she practiced and taught clinical medicine at hospitals in London for a decade before entering a career in health education and technology.

Reviewed by:

John Strickler, MD

John Strickler, MD, joined the Duke University faculty in 2011 and is now an associate professor of medicine in the division of medical oncology. His research focuses on precision cancer medicine: identification of genomic biomarkers that predict sensitivity or resistance to targeted therapies and immunotherapy.

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