Everyone, at some point, needs colorectal cancer screening. When to start screening depends on a few things:

• Age: If you’re age 45 or older, you need to be screened. Screening should continue until age 75, which at that time, you should have a discussion with your doctor regarding risks and benefits about continuing screening.
• Family history: If biological family members 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 screening).

Do I have options on how to get screened?

It depends. If you have a family history of colorectal cancer or a genetic syndrome, you’ll need a screening colonoscopy. This will allow a doctor to visually see inside your colon and either remove any colon polyps and/or biopsy any concerning areas—all during one procedure.

If you do not have a family history or genetic syndrome and are getting screened because you have turned 45, you have several screening test options.

Here are the most common methods of colorectal cancer screening:

• Colonoscopy
• Stool Test: FIT(Fecal Immunochemical Test)
• Stool Test: FIT-DNA/mt-sDNA (i.e. Cologuard®)
• CT Colonography
• Flexible Sigmoidoscopy (Flex Sig)
• Capsule Colonoscopy
• Blood-Based Tests

Read more about each colorectal cancer screening option.

I’m getting a colonoscopy: What should I now?

A colonoscopy is a great choice for colorectal cancer screening: Many lives have been saved, and colorectal cancers prevented, because patients underwent one.

Read more about a colonoscopy, colonoscopy prep tips, and what to do if your doctor finds a polyp or cancer on our colonoscopy page.

What doctor should I see for colon cancer screening?

Most patients see a general internist, a primary care doctor, or an OB-GYN doctor to make decisions about what colorectal cancer screening test is best for them.

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 an at-home test or other non-invasive test for colorectal cancer screening if these are preferred over colonoscopy. Please note that if this test result is abnormal (also referred to a “positive”), you will be sent to a gastroenterologist for a follow-up colonoscopy to look for polyps, cancers, or other reasons why the test result was abnormal.

If you’re looking for a gastroenterologist who can perform your colorectal cancer screening, start your search in our Provider Finder.

Will insurance cover colorectal cancer 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 getting screened because you have reached screening age

If you’re age 45 or older, and you’re getting screened because it’s time—you aren’t seeing signs and symptoms—your screening should be covered 100% and come at no cost to you. This should be the case each time you repeat your screening—as recommended by your doctor.

This colonoscopy is considered a “screening 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 during the procedure if you have commercial insurance. If you have Medicare, you may have some cost-sharing if a polyp is removed during a screening colonoscopy. This “loophole” is currently being phased out thanks to decades of advocacy.

(Contact our advocacy team if you have private insurance and you’re getting charged for having a polyp removed during a screening colonoscopy.)

For the majority of patients, the at-home tests, like a FIT or FIT-DNA (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 patients 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.

Click here to get follow-up colonoscopy resources.

If you’re having symptoms, high risk, or a genetic syndrome

If you are having signs and symptoms concerning for colorectal cancer—no matter your age—this is actually considered a diagnostic procedure rather than a screening 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 me with the cost of screening?

Several programs exist around the country that can help you pay for a colonoscopy and/or get a free colonoscopy. Here are a few resources to explore:

• Colonoscopy Assist: Financial assistance for those needing help with screening costs.
• Cancer Care: Enter your zip code to find screening resources near you.
• Patient Advocate Foundation: Enter your zip code and search for “screening services” for “colon cancer.”

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 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.

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. (Fight CRC played a role—read how!)

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. Share your story now.
• Funding research. Research leads to the data that’s needed to make changes to a screening age. Give today.

What if I got screened, and it found cancer?

We are proud of you for getting screened. We also are sorry to hear of your diagnosis. But if you are reading this, you have found your people. We are a community who “get it,” and a lot of our stories began this same way. We are here to be your guide in the fight as you face colorectal cancer head on. Not only are we here to guide you; we’re also here to support you.

If you’re newly diagnosed, start here.

Free Screening Resources

Get our Colorectal Cancer Screening brochure (available in English, Spanish, and Chinese) and other screening resources.

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