Colorectal Cancer Screening:
You Have Options
Everyone, at some point, needs colorectal cancer screening. When to start screening depends on a few things like
age, family history, genetics, and if you’re seeing any symptoms. There are several ways to get screened.
Colorectal Cancer Screening:
You Have Options
Everyone, at some point, needs colorectal cancer screening. When to start screening depends on a few things like age, family history, genetics, and if you’re seeing any symptoms. There are several ways to get screened.
When to start screening
When to start screening depends on a few things:
Age: If you’re age 45 or older, you need to be screened. You should get screened until age 75. At that time, ask your doctor about the risks versus the benefits of continuing to get screened.
Family history: If blood relatives have been diagnosed with colon cancer or rectal cancer, you may need to start screening at age 40 or earlier. The age to start will depend on their connection to you and their age at diagnosis.
Genetics: If you have certain genetic syndromes, you will need to start screening earlier and undergo screening more frequently than people without a genetic syndrome.
Symptoms: If you’re seeing any signs or symptoms of colorectal cancer, you will need medical evaluation right away—regardless of your age. (This is called a diagnostic work-up rather than a screening.)
What doctor should I see if I need screening?
Most patients start by asking their general internist, a primary care doctor, or an OB-GYN about colorectal cancer screening. If the choice is a colonoscopy, these doctors can place a referral to a gastroenterologist (GI) for the procedure. GIs are licensed professionals with specialty training on how to diagnose and treat disorders of the entire digestive tract. A gastroenterologist is trained in colonoscopy and endoscopy procedures. (In some cases, colorectal surgeons may also perform colonoscopy procedures.)
Your primary care doctor can also order a non-invasive test for colorectal cancer screening if preferred. If this test result is abnormal, you will be sent to a gastroenterologist for a follow-up colonoscopy. This procedure will look for polyps, cancers, or other reasons why the test result was abnormal.
When to start screening
When to start screening depends on a few things:
Age: If you’re age 45 or older, you need to be screened. You should get screened until age 75. At that time, ask your doctor about the risks versus the benefits of continuing to get screened.
Family history: If blood relatives have been diagnosed with colon cancer or rectal cancer, you may need to start screening at age 40 or earlier. The age to start will depend on their connection to you and their age at diagnosis.
Genetics: If you have certain genetic syndromes, you will need to start screening earlier and undergo screening more frequently than people without a genetic syndrome.
Symptoms: If you’re seeing any signs or symptoms of colorectal cancer, you will need medical evaluation right away—regardless of your age. (This is called a diagnostic work-up rather than a screening.)
What doctor should I see if I need screening?
Most patients start by asking their general internist, a primary care doctor, or an OB-GYN about colorectal cancer screening. If the choice is a colonoscopy, these doctors can place a referral to a gastroenterologist (GI) for the procedure. GIs are licensed professionals with specialty training on how to diagnose and treat disorders of the entire digestive tract. A gastroenterologist is trained in colonoscopy and endoscopy procedures. (In some cases, colorectal surgeons may also perform colonoscopy procedures.)
Your primary care doctor can also order a non-invasive test for colorectal cancer screening if preferred. If this test result is abnormal, you will be sent to a gastroenterologist for a follow-up colonoscopy. This procedure will look for polyps, cancers, or other reasons why the test result was abnormal.
Do I have options on how to get screened?
It depends based on your risk factors. If you are high or hereditary risk, you need a colonoscopy. This will allow a doctor to visually see inside your colon and remove any polyps and/or biopsy any concerning areas. This all happens during one procedure.
If you are average-risk and getting screened because you are 45 or older, you have several screening test options.
Do I have options on how to get screened?
It depends based on your risk factors. If you are high or hereditary risk, you need a colonoscopy. This will allow a doctor to visually see inside your colon and remove any polyps and/or biopsy any concerning areas. This all happens during one procedure.
If you are average-risk and getting screened because you are 45 or older, you have several screening test options.
Will insurance cover screening?
If you are insured, your insurance will cover your screening in most cases. However, how much is covered may depend on the specifics of your medical plan.
If you’re age 45 or older, and you’re getting screened because of your age, your screening costs should be covered 100%. This means you are not seeing signs or symptoms. This should be the case each time you repeat your screening—as recommended by your doctor.
This colonoscopy is considered a “screening colonoscopy,” or “surveillance colonoscopy,” and you won’t have to pay any out-of-pocket costs for it. For a screening colonoscopy, insurance should also cover the cost of polyp removal if you have commercial insurance. If you have Medicare, you might need to pay some money if a doctor takes out a polyp during a colonoscopy.
For the majority of patients, the at-home tests, like a FIT or mt-sDNA (Cologuard) are covered by insurance. If the test result is abnormal and a follow-up colonoscopy is needed, patients with private insurance, Medicare and most Medicaid plans should not have out-of-pocket costs.
This is a recent change following extensive advocacy from Fight CRC and our partners. If you receive a bill for a colonoscopy after an abnormal non-invasive screening test, please contact our advocacy team for assistance in appealing to your insurer.
If you’re having symptoms, high risk, or a genetic syndrome
If you have signs and symptoms for colorectal cancer—no matter your age—this is considered a diagnostic procedure. Coverage varies across insurers. Depending on your plan, you may be responsible for your deductible and any co-insurance costs. The same also goes for screening for high-risk patients, which is called “surveillance” rather than “screening.”
Learn more about insurance coverage for colorectal cancer screening from the American Cancer Society.
Are there any programs to help with the cost of screening?
Will insurance cover screening?
If you are insured, your insurance will cover your screening in most cases. However, how much is covered may depend on the specifics of your medical plan.
If you’re age 45 or older, and you’re getting screened because of your age, your screening costs should be covered 100%. This means you are not seeing signs or symptoms. This should be the case each time you repeat your screening—as recommended by your doctor.
This colonoscopy is considered a “screening colonoscopy,” or “surveillance colonoscopy,” and you won’t have to pay any out-of-pocket costs for it. For a screening colonoscopy, insurance should also cover the cost of polyp removal if you have commercial insurance. If you have Medicare, you might need to pay some money if a doctor takes out a polyp during a colonoscopy.
Contact our advocacy team if you have private insurance and you’re getting charged for a polyp removal during a screening colonoscopy.
For the majority of patients, the at-home tests, like a FIT or mt-sDNA (Cologuard), are covered by insurance. If the test result is abnormal and a follow-up colonoscopy is needed, patients with private insurance, Medicare and most Medicaid plans should not have out-of-pocket costs.
This is a recent change following extensive advocacy from Fight CRC and our partners. If you receive a bill for a colonoscopy after an abnormal non-invasive screening test, please contact our advocacy team for assistance in appealing to your insurer.
If you’re having symptoms, high risk, or a genetic syndrome
If you have signs and symptoms for colorectal cancer—no matter your age—this is considered a “diagnostic procedure.” Coverage varies across insurers. Depending on your plan, you may be responsible for your deductible and any co-insurance costs. The same also goes for screening for high-risk patients, which is called “surveillance” rather than “screening.”
Learn more about insurance coverage for colorectal cancer screening from the American Cancer Society.
Are there any programs to help with the cost of screening?
What types of results will I get?
Your screening results will depend on the type of colorectal cancer screening you had. After a colonoscopy, for example, you will receive a report that states whether there were polyps in the colon or rectum or changes suspicious for colorectal cancer.
At-home test results, however, will be either abnormal (positive) or normal (negative). Your screening report and follow-up, no matter what screening method you chose, need to be
discussed with your doctor.
What types of results will I get?
Your screening results will depend on the type of colorectal cancer screening you had. After a colonoscopy, for example, you will receive a report that states whether there were polyps in the colon or rectum or changes suspicious for colorectal cancer.
At-home test results, however, will be either abnormal (positive) or normal (negative). Your screening report and follow-up, no matter what screening method you chose, need to be
discussed with your doctor.
Who decided when people should get screened?
Years of research, data, and public comments go into the decisions like the age to start screening.
Multiple professional organizations publish guidelines on colorectal cancer screening, including the U.S. Preventive Services Task Force (USPSTF), United States Multi-Society Task Force (US-MSTF), the National Comprehensive Cancer Network (NCCN), the American Cancer Society (ACS), and the American College of Physicians (ACP). These guidelines are formed after an extensive review of research data, and all but one of these organizations recommend screening from at least age 45 to 75.
Typically, insurance companies (including Medicare) follow the USPSTF recommendations. In fact, under the Affordable Care Act (ACA), any USPSTF guideline that has a grade “A” or grade “B” designation is mandated to be covered by insurance companies without any cost-sharing to the patient. The USPSTF reviews (and if necessary, updates) guidelines every five years.
Published guidelines on colorectal cancer screening
Why isn’t the screening age for colon cancer lower than 45? How can we lower it?
In 2018 when the American Cancer Society lowered its recommended screening age from 50 to 45, years of research, data analysis, risk and reward comparisons, and public comments went into the decision. A few years later, the USPSTF followed this guidance and updated its recommendations to also recommend screening starting at age 45. Most payers and providers soon began following the updated recommendations.
There is ongoing review of data to inform the right age to start screening, especially with increasing rates of colorectal cancer in young adults.
Changing the screening age on a national level is not a quick and easy decision; however, there are steps we are taking as advocates every day to keep this issue front of mind:
- Gathering stories. Stories keep screening-age recommendations and the need for continual review front and center.
- Funding research. Research leads to the data that’s needed to make changes to a screening age.
What if my doctor refuses to screen me?
It’s important to be your own advocate. If you know you are due for screening or if you have signs and symptoms that warrant a diagnostic colonoscopy, keep asking until you find a doctor who will listen. You know your body. Do not be embarrassed or ashamed, and do not stop advocating to get the medical care you need.
Our Provider Finder is a great place to start if you’re looking for a second opinion.
Who decided when people should get screened?
Years of research, data, and public comments go into the decisions like the age to start screening.
Multiple professional organizations publish guidelines on colorectal cancer screening, including the U.S. Preventive Services Task Force (USPSTF), United States Multi-Society Task Force (US-MSTF), the National Comprehensive Cancer Network (NCCN), the American Cancer Society (ACS), and the American College of Physicians (ACP). These guidelines are formed after an extensive review of research data, and all but one of these organizations recommend screening from at least age 45 to 75.
Typically, insurance companies (including Medicare) follow the USPSTF recommendations. In fact, under the Affordable Care Act (ACA), any USPSTF guideline that has a grade “A” or grade “B” designation is mandated to be covered by insurance companies without any cost-sharing to the patient. The USPSTF reviews (and if necessary, updates) guidelines every five years.
Here is the most recent USPSTF guidance on colorectal cancer screening.
Published guidelines on colorectal cancer screening
Why isn’t the screening age for colon cancer lower than 45? How can we lower it?
In 2018 when the American Cancer Society lowered its recommended screening age from 50 to 45, years of research, data analysis, risk and reward comparisons, and public comments went into the decision. A few years later, the USPSTF followed this guidance and updated its recommendations to also recommend screening starting at age 45. Most payers and providers soon began following the updated recommendations.
There is ongoing review of data to inform the right age to start screening, especially with increasing rates of colorectal cancer in young adults.
Changing the screening age on a national level is not a quick and easy decision; however, there are steps we are taking as advocates every day to keep this issue front of mind:
- Gathering stories. Stories keep screening-age recommendations and the need for continual review front and center.
- Funding research. Research leads to the data that’s needed to make changes to a screening age.
What if my doctor refuses to screen me?
It’s important to be your own advocate. If you know you are due for screening or if you have signs and symptoms that warrant a diagnostic colonoscopy, keep asking until you find a doctor who will listen. You know your body. Do not be embarrassed or ashamed, and do not stop advocating to get the medical care you need.
Our Provider Finder is a great place to start if you’re looking for a second opinion.
If you’re age 45+ or have a family history of colorectal cancer this Screening brochure is for you.
If you’re age 45+ or have a family history of colorectal cancer this Screening brochure is for you.
