Depending on your risk, you and your doctor will need to form a plan for your screening based on several colorectal cancer screening options. Here are several screening methods to consider:

Colonoscopy

Colonoscopy has often been considered the “gold standard” for colorectal cancer screening because it can identify polyps and remove them during the same procedure. A doctor (most often a gastroenterologist) inserts a colonoscope (a thin, flexible tube) into the colon and guides it all the way through to the cecum (where the colon begins and the small bowel ends) to get a good look inside every fold and turn of your colon and rectum.

The colonoscope has a digital camera and light attached to the end that allows doctors to see any abnormalities and a tool to remove polyps while the procedure is taking place. This is why a colonoscopy is often referred to as a direct visualization test. 

To undergo a colonoscopy, the entire colon must be cleaned out. This process is called colonoscopy prep, or simply “prep,” and it involves taking a laxative and following dietary restrictions. Most often, patients are required to adhere to a clear liquid diet the day before the procedure. Read colonoscopy prep tips.

• Repeated every 10 years, if normal. 
• Performed at an outpatient surgical center or hospital.
• Bowel prep required.
• If you’re age 45 or older and you’re getting screened for prevention, your screening should be covered 100% and come at no cost to you. You won’t have to pay any out-of-pocket costs for it. Insurance should also cover the cost of polyp removal during the procedure if you have commercial insurance.
• Complications are rare but can include bleeding, infection, and bowel-wall injury.
• Most people are good candidates. This test is among the best ways to find and remove polyps early. 

Colonoscopy is the only screening option if you’re experiencing symptoms or if you are high or hereditary risk for colorectal cancer.

Capsule Colonoscopy

A unique type of screening that involves swallowing a vitamin-size pill that contains a wireless camera. A capsule colonoscopy is different in that it is able to image the entire digestive tract—from mouth to rectum. This includes imaging areas that are not normally seen by a traditional colonoscopy, such as the small intestine.

The capsule will be given to you at your physician’s office. After swallowing it, you are free to go home. You will either need to return to your physician’s office to return the external recording equipment, or you may need to retrieve the capsule from your stool and return it, depending on which specific capsule you were given.

This is generally a low-risk screening option, but there is a possibility that the capsule can become stuck and must be retrieved surgically.

• Repeat every five years, if normal,
• Takes place at a physicians office and at home.
• Costs vary by insurance, but screening tests must typically be covered.
• A capsule colonoscopy is typically only an option for individuals who cannot or will not tolerate a traditional colonoscopy. Discuss this option with your physician if you are interested.
• If polyps or abnormalities are found, a follow-up colonoscopy is required.

Colorectal Cancer Screening Options: Stool Tests

Stool tests are typically done at home. Each comes with a set of instructions that are important to follow because each test is unique. For stool tests to work, you MUST do them regularly (annually or every 3 years, depending on the test). You will not have to touch the stool (but do a thorough hand washing once you’ve collected the sample).

Get a stool test for colorectal cancer from your health care provider. Stool-based tests are covered by the vast majority of insurers, including private insurance, Medicare, and many Medicaid plans.

Both FIT and mt-sDNA tests must be ordered by a clinician, most commonly a primary care clinician, although the tests can be ordered through urgent care centers, retail clinics, or independent telehealth providers.

FIT-DNA/mt-sDNA (Cologuard)

This is an at-home test that looks for abnormal sections of DNA within the stool in addition to small traces of blood. You will be given detailed instructions about how to use and return the kit at home, including where to send it when completed.

• One stool sample is needed. 
• Repeat every 3 years, if normal. 
• Performed at home.
• No bowel prep required.
• Screening tests must be covered by insurance. Coverage for follow-up colonoscopy, if needed due to a positive test result, should also be covered by insurance. Cologuard offers a patient assistance program to help patients facing challenges with insurance coverage.
• It can’t detect or remove polyps. If you receive a positive test result, a follow-up colonoscopy is required. 
• Many average-risk people are good candidates, especially if hesitant about a colonoscopy. 

Fit Test (Fecal Immunochemical Test)

Stool is collected at home and sent to a lab, which looks for small amounts of blood. You will be given instructions about how to use the kit at home, and where to send it when completed. There are no drug or dietary restrictions to take the test.

• One stool sample is needed.
• Repeat every year, if normal. 
• An affordable option for many patients.
• Performed at home.
• No bowel prep required.
• Screening tests must be covered by insurance. Coverage for a follow-up colonoscopy, if needed due to a positive test result, should also be covered by insurance. 
• It can’t detect or remove polyps. If you receive a positive test result, a follow-up colonoscopy is required. 
• Many average-risk people are good candidates, especially if hesitant about a colonoscopy and on a budget, but it must be performed every year. 

gfOBT

Stool is collected at home and sent to a lab, which looks for small amounts of blood. You will be given instructions about how to use the kit at home, which medications and foods to avoid (such as non-steroidal anti-inflammatory drugs [NSAID] like ibuprofen and others) and where to send it when completed. Three stool samples are needed. This test is no longer commonly used and has been mostly replaced by FIT.

Virtual Colonoscopy

A noninvasive, advanced CT scan of the colon and rectum that produces two- and three-dimensional images of the colon and rectum, allowing the doctor to look for polyps or cancer within the images. The entire colon must be cleaned out for this procedure, just like a traditional colonoscopy. If abnormalities are found, your doctor will talk to you about the appropriate diagnostic procedure moving forward. Not everyone is a candidate for CT colonography, so be sure to talk to your doctor about this colorectal cancer screening option.

• Repeat every 5 years. 
• Performed at a hospital, clinic, or outpatient imaging center.
• Requires bowel prep.
• Should be covered by insurance, but you may want to discuss with your insurance provider before undergoing this screening exam.
• If any abnormalities are found, such as polyps, a follow-up colonoscopy is required.
• May be a good option for people who aren’t eligible or cannot tolerate a traditional colonoscopy.

Flexible Sigmoidoscopy

A doctor uses a tool called a sigmoidoscope to look at the sigmoid colon (the last section of the bowel) and the rectum, removing any visible polyps. This is different from a colonoscopy because a colonoscopy allows the doctor to see the entire large intestine.

Because less than half of the large intestine and all of the rectum can be seen with this method, they are often done in combination with the gFOBT or FIT to test for blood in the stool. Prior to this procedure, an enema is done to clean out the lower part of the colon and the rectum.

• Repeat every five years or in combination with FIT or gFOBT, If normal.
• Performed at outpatient surgical center or hospital.
• Enema is done prior to procedure.
• This test does not visualize the entire colon, so it is not as thorough as a traditional colonoscopy.
• Most people are good candidates. Discuss this option with your physician to determine if it is appropriate for you.

Blood-Based Tests as a Colorectal Cancer Screening Option

There are currently no FDA approved blood-based screening tests. However, the research is accelerating quickly and options are rapidly emerging.

Manufacturers are working to secure FDA approval. It is best to call your insurance provider to determine screening tests that are and are not covered, and to work with your doctor on the best screening plan for you.

Single-Organ Blood Screening Test

• These look at only one type of cancer.
• A yearly sample needs to be taken.
• If you receive a positive result, a follow-up colonoscopy is necessary.

Multi-Cancer Early Detection (MCED) Screening Tests

• Some can detect more than 50 types of cancers in one test.
• These are designed to focus on tumors that are more aggressive.
• They are used alongside single-organ tests for more accurate results.

Screening Resources

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