March 12th, 2026
By Ravikant Varanasi, MD, AGAF
March is National Colon Cancer Awareness Month, so there is no better time to discuss the topic of colon cancer screening.
Colon cancer is one of the most common and deadly cancers in the United States, but it is also one of the most preventable. Can you think of another cancer that can be PREVENTED with screening? Lung cancer, breast cancer, prostate cancer, pancreatic cancer, etc. All of these potentially deadly cancers have screening tests, but none of these tests can prevent the disease being screened. Because colon cancer usually develops slowly from small growths called polyps that form in the lining of the colon or rectum, screening can be highly effective. Screening can find these polyps before they turn into cancer, allowing doctors to remove them and prevent cancer from ever developing. Screening can also detect cancer at an early stage when it is most treatable.
The good news is that regular screening has been proven to save lives. Studies show that screening reduces deaths from colon cancer and can decrease the chance of developing the disease in the first place.
Most major medical organizations now recommend that adults at average risk begin colon cancer screening at age 45. This recommendation was recently lowered from age 50 because colon cancer rates have been increasing in younger adults. In fact, colorectal cancer is now the leading cause of cancer-related death in Americans under 50 years of age. If you are in good health, you should continue regular screenings through age 75.
For people aged 76 to 85, the decision to continue screening should be made individually with your doctor, considering your overall health, life expectancy, and whether you have been screened before. People over 85 generally should not undergo screening, as the benefit of screening is limited.
You may need to start screening earlier or get screened more often if you have certain risk factors, including a family history of colon cancer or polyps, inflammatory bowel disease, or certain genetic conditions. Talk to your doctor about your personal risk.
One of the most important things to know about colon cancer screening is that you have options. Research shows that offering different test choices increases the number of people who get screened, and the best test is the one you will actually complete. Your doctor can help you choose the method that is right for you based on your preferences and health status.
Colonoscopy is the most comprehensive screening option, and the only one-step test available. During this procedure, a doctor uses a flexible tube with a camera to examine your entire colon. If polyps are found, they can be removed during the same procedure.
The procedure requires a bowel preparation (diet modification for a few days and then drinking a special solution to clean out your colon) and sedation during the exam, so you will need someone to drive you home. If your colonoscopy is normal, you typically will not need another one for 10 years.
Stool-based tests look for signs of cancer or polyps in your stool sample. These tests can be done at home and do not require bowel preparation or sedation. However, a stool-based test is a two-step test, because if it is positive, you will need a follow-up colonoscopy. There are two commonly used stool-based tests.
The fecal immunochemical test (FIT) is the most frequently used stool test. It detects blood in the stool and has about 74-81% sensitivity for detecting colon cancer. FIT requires collecting a single stool sample and must be done every year. It is more convenient than older stool tests because it does not require dietary restrictions.
Multi-target stool DNA tests (such as Cologuard) look for both blood and DNA markers of cancer in the stool. These tests detect about 93% of colon cancers and 43-47% of advanced polyps. They require collecting an entire bowel movement and are done every three years.
CT colonography (also called virtual colonoscopy) uses X-ray images to examine the colon and is done every five years, though insurance coverage for this procedure is often limited. Flexible sigmoidoscopy examines only the lower part of the colon and is typically combined with annual FIT. These options may be appropriate for some people but are less commonly used and probably less effective than colonoscopy or stool tests.
Each screening method has advantages and disadvantages. Colonoscopy is the most accurate test and allows for immediate polyp removal, but it requires bowel preparation and time off work. Stool tests are convenient and can be done at home, but they need to be repeated more frequently and may miss some polyps. Additionally, positive stool tests require follow up colonoscopy.
Studies comparing these methods show that colonoscopy detects more polyps than stool tests in a single screening, but when FIT is done annually as recommended, it can be similarly effective over time at preventing colon cancer deaths. The key is choosing a test you are comfortable with and completing it regularly according to the recommended guidelines. No test can be effective if it is not completed.
If you have a positive stool test or abnormalities you will need a follow-up colonoscopy. This should be done as soon as possible and no later than within nine months. Research shows that delays beyond this timeframe may increase the risk of finding more advanced abnormalities including cancer.
If polyps are found and removed during colonoscopy, your doctor will recommend a follow-up schedule based on the number, size, and type of polyps found.
The most important message about colon cancer screening is this: GET SCREENED. Colon cancer is highly preventable and treatable when caught early, but only if you participate in regular screening.
Talk to your doctor about which screening method is best for you. Consider factors like your personal preferences, family history, overall health, and what tests are available in your area. If one method seems too difficult or unpleasant, ask about alternatives. The goal is to find a screening approach you will stick with over time.
Do not let fear, embarrassment, or inconvenience prevent you from getting screened. The temporary discomfort of screening is far better than facing advanced colon cancer that could have been prevented. You can always find a reason to delay colon cancer screening, but getting it done will give you peace of mind. After going through the process, most people find it easier than they had expected. And who knows...it may just save your life.
Dr. Varanasi is a Fellow of the American Gastroenterological Association and accepts new patients; visit pinehurstmedical.com to learn more or call (919) 292-6110 to schedule an appointment.
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