Colorectal Cancer Screening: Tests, Age, and Guidelines
"Learn when to start colorectal cancer screening, compare tests, and understand follow-up after a positive result."
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| Illustration. A doctor explains cancer examination and treatment to a patient at a hospital. |
For adults at average risk in the United States, the American Cancer Society recommends starting regular colorectal cancer screening at age 45.
There is no single test that is best for everyone.
Screening options include:
colonoscopy;
stool-based tests such as FIT;
multitarget stool DNA tests such as Cologuard;
multitarget stool RNA testing;
and certain blood-based screening tests.
The right choice depends on a person's age, risk factors, medical history, preferences, access to care and willingness to complete follow-up testing.
One of the most important rules is often overlooked:
A positive stool-based or blood-based screening test generally needs to be followed by a colonoscopy.
A screening test is not the same thing as a diagnostic test.
Medical information: This article is for educational purposes only and does not replace medical advice. Colorectal cancer screening recommendations can differ for people with symptoms, a personal history of colorectal cancer or polyps, inflammatory bowel disease, certain inherited cancer syndromes, or a strong family history.
At What Age Should You Start Colorectal Cancer Screening?
For adults at average risk, the American Cancer Society recommends starting colorectal cancer screening at age 45.
The recommendation applies to both men and women.
People ages 45 through 75 should receive regular colorectal cancer screening if they are in good enough health to benefit from screening.
For adults ages 76 through 85, the decision should be individualized based on:
overall health;
life expectancy;
previous screening history;
personal preferences;
and the potential benefits and harms of screening.
Screening is generally not recommended after age 85.
The exact recommendation can differ for people who are not at average risk.
Why Does Colorectal Cancer Screening Start at 45?
Colorectal cancer has increasingly affected adults younger than traditional screening ages.
The American Cancer Society lowered its recommended starting age for average-risk adults from 50 to 45.
The change reflects evidence showing increasing colorectal cancer incidence among younger adults.
Starting screening at 45 gives doctors an opportunity to detect cancer earlier and identify precancerous growths before they develop into cancer.
The important point is that age 45 applies to average-risk screening.
Someone with significant risk factors may need to start earlier.
Who Is Considered Average Risk for Colorectal Cancer?
Average risk generally means a person does not have certain factors that substantially increase the likelihood of colorectal cancer.
A person may be at higher-than-average risk because of:
a personal history of colorectal cancer;
previous adenomatous polyps or certain other colorectal polyps;
inflammatory bowel disease such as ulcerative colitis or Crohn's disease;
a family history of colorectal cancer or certain polyps;
an inherited syndrome such as Lynch syndrome or familial adenomatous polyposis;
or previous radiation involving the abdomen or pelvis in certain circumstances.
People with these risk factors may need a different screening schedule or a colonoscopy rather than one of the routine average-risk options.
If you have a strong family history or previous polyps, do not simply follow an average-risk screening schedule without discussing it with a healthcare professional.
What Are the Colorectal Cancer Screening Options in 2026?
For average-risk adults, the ACS lists several screening options.
These can broadly be divided into two groups.
Stool-based tests
These include:
fecal immunochemical test (FIT) every year;
multitarget stool DNA testing every 3 years;
multitarget stool RNA testing every 3 years.
Visual examinations
These include:
colonoscopy every 10 years;
CT colonography every 5 years;
flexible sigmoidoscopy every 5 years.
The ACS also includes certain blood-based colorectal cancer screening tests at specified intervals.
The best test is not necessarily the most technologically sophisticated one.
A screening test is useful only if a person actually completes it at the recommended interval and completes the necessary follow-up if the result is abnormal.
What Is the Best Colorectal Cancer Screening Test?
There is no single best test for every person.
Colonoscopy has an important advantage because doctors can directly examine the colon and remove many polyps during the same procedure.
Stool-based tests are less invasive and can be performed at home.
Blood-based screening may be another option for certain average-risk adults.
The choice can therefore involve a tradeoff between:
sensitivity;
convenience;
preparation;
cost;
frequency;
invasiveness;
and follow-up requirements.
A test that someone is willing to complete consistently may be more useful than a test they repeatedly avoid.
Colonoscopy vs. Stool Test: What Is the Difference?
The biggest difference is what happens after an abnormal result.
Colonoscopy
A colonoscopy allows a clinician to directly inspect the colon.
During the procedure, polyps can often be removed or biopsied.
If the colonoscopy is normal, average-risk screening is generally repeated every 10 years.
Stool-based test
A stool-based test looks for signs associated with colorectal cancer or precancerous lesions.
It can usually be completed at home.
However, if the result is positive, the patient generally needs a follow-up colonoscopy.
That means a stool test is not a way to permanently avoid colonoscopy.
It is an alternative first-step screening strategy for appropriate average-risk adults.
How Often Should You Get a Colonoscopy?
For average-risk adults, the American Cancer Society recommends colonoscopy every 10 years beginning at age 45.
The 10-year interval applies when the colonoscopy is being used for routine average-risk screening and the examination is otherwise considered appropriate.
It does not mean every person should wait 10 years after any colonoscopy.
People with polyps, previous colorectal cancer, certain family histories or other risk factors may need colonoscopy more frequently.
The interval after a colonoscopy can therefore depend on what was found.
How Often Should You Do a FIT Test?
A fecal immunochemical test, commonly called FIT, is performed every year for average-risk colorectal cancer screening.
FIT detects hidden blood in stool.
Because the test is designed to be repeated regularly, skipping years can reduce the effectiveness of the overall screening strategy.
If a FIT result is positive, the next step is generally a colonoscopy.
Repeating another FIT instead of completing the recommended diagnostic follow-up does not provide the same evaluation.
How Often Is Cologuard Used?
Multitarget stool DNA testing, commonly associated with the brand Cologuard, is an at-home stool-based screening option.
The American Cancer Society lists multitarget stool DNA testing as an option every 3 years for average-risk adults.
The test combines molecular analysis with detection of blood-related signals in stool.
As with FIT, a positive result requires follow-up colonoscopy.
Cologuard is therefore a screening test, not a diagnostic replacement for colonoscopy.
What Is Multitarget Stool RNA Testing?
Multitarget stool RNA testing is another stool-based colorectal cancer screening option.
The American Cancer Society includes multitarget stool RNA testing as an option every three years for appropriate average-risk adults.
This category is newer than traditional FIT testing and differs from multitarget stool DNA testing.
Patients should follow the instructions for the specific test they receive because different tests have different collection and processing requirements.
A positive result requires follow-up evaluation, generally including colonoscopy.
Are There Blood Tests for Colorectal Cancer Screening?
Yes.
Blood-based colorectal cancer screening has become another option for certain average-risk adults.
The American Cancer Society includes approved blood-based screening tests among colorectal cancer screening options.
However, blood-based tests have important limitations.
Compared with established stool-based screening tests, blood tests can have lower sensitivity for detecting advanced precancerous lesions.
A blood test should therefore not automatically be considered equivalent to colonoscopy.
The specific test, its FDA authorization, screening interval and follow-up requirements should be considered.
What Happens If a Colorectal Cancer Screening Test Is Positive?
A positive screening result does not automatically mean you have colorectal cancer.
It means that additional evaluation is needed.
For stool-based and blood-based screening tests, that generally means a colonoscopy.
The colonoscopy allows doctors to determine whether there is:
a precancerous polyp;
colorectal cancer;
another source of bleeding;
or no significant abnormality.
The important point is that the screening process is not complete when the stool or blood test comes back positive.
The follow-up colonoscopy is an essential part of completing the evaluation.
How Soon Should You Get a Colonoscopy After a Positive Stool Test?
The American Cancer Society recommends completing follow-up colonoscopy after a positive non-colonoscopy screening test, preferably within six months.
The reason is straightforward.
A positive screening test has identified a potential abnormality that needs direct evaluation.
Delaying the follow-up for too long can reduce the benefit of screening.
If your stool test is positive, contact your healthcare professional promptly and ask when the diagnostic colonoscopy should be scheduled.
Can You Do Colorectal Cancer Screening at Home?
Yes.
Several colorectal cancer screening options can be completed at home.
FIT is one example.
Multitarget stool DNA testing is another.
Some blood-based tests are collected through healthcare settings rather than at home, depending on the test.
At-home screening can make participation easier for people who are uncomfortable with colonoscopy preparation or sedation.
But convenience should not obscure the follow-up requirement.
If the test is positive, a colonoscopy is generally still necessary.
Is a Colonoscopy Better Than Cologuard?
"Better" depends on what you mean.
Colonoscopy has the advantage of directly examining the colon and allowing doctors to remove many polyps during the procedure.
Cologuard is less invasive and can be performed at home.
But Cologuard requires more frequent testing, and a positive result requires colonoscopy.
For some people, colonoscopy may be the preferred screening method.
For others, completing an at-home stool test every three years may be more acceptable than avoiding screening altogether.
The key is to choose an evidence-based screening method and complete it consistently.
What If You Do Not Want a Colonoscopy?
You still have screening options if you are an average-risk adult.
Depending on your circumstances, alternatives can include:
annual FIT;
multitarget stool DNA testing every three years;
multitarget stool RNA testing every three years;
certain blood-based tests;
CT colonography every five years;
or flexible sigmoidoscopy at recommended intervals.
However, some alternatives eventually lead to colonoscopy if the result is abnormal.
Therefore, someone choosing an alternative should be prepared to undergo colonoscopy if the screening test identifies a concerning result.
Do You Need a Colonoscopy if Your FIT Is Negative?
If you are an average-risk adult and your FIT is negative, you generally continue annual FIT screening according to the recommended schedule.
A negative FIT does not mean that a person will never develop colorectal cancer.
It means no concerning signal was detected by that particular test at that time.
Because colorectal cancer can develop later, regular repeat screening is important.
If you develop symptoms despite a negative screening test, talk with a healthcare professional rather than waiting for the next routine screening test.
What Symptoms Should Not Wait for Routine Screening?
Screening is intended for people without symptoms.
If you have concerning symptoms, the appropriate evaluation may be diagnostic rather than routine screening.
Symptoms can include:
blood in or on the stool;
unexplained changes in bowel habits;
persistent abdominal discomfort;
unexplained weight loss;
iron-deficiency anemia;
or other concerning gastrointestinal symptoms.
A person with symptoms should not rely on a negative at-home screening test as proof that there is no cancer.
Talk with a healthcare professional about the appropriate diagnostic evaluation.
Does Family History Change When You Should Start Screening?
Yes.
Family history can change colorectal cancer screening recommendations.
Someone with a first-degree relative who had colorectal cancer or certain advanced polyps may need to begin screening earlier or undergo screening more frequently than an average-risk adult.
The exact recommendation depends on factors such as:
which relative was affected;
the relative's age at diagnosis;
the number of affected relatives;
and the type of polyp or cancer involved.
Because family-history recommendations can be more complicated than a simple age rule, discuss your personal history with a healthcare professional.
Do Black Americans Need to Start Colorectal Cancer Screening Earlier?
The current American Cancer Society recommendation for average-risk adults is to begin regular colorectal cancer screening at age 45.
Earlier recommendations specifically advocated an earlier starting age for Black adults because colorectal cancer incidence and mortality have historically been higher in Black Americans.
However, current screening guidance should be interpreted using the latest recommendations rather than relying on older age-specific rules.
Risk factors and family history can still justify earlier or more intensive screening.
Does Insurance Cover Colorectal Cancer Screening?
Many insurance plans cover recommended preventive colorectal cancer screening, but coverage depends on the type of insurance, the specific test, age, network and applicable rules.
Medicare also covers several colorectal cancer screening services under its preventive-care benefits, subject to eligibility and coverage requirements.
A key issue is what happens after an abnormal screening result.
The follow-up colonoscopy may be classified differently from the original preventive screening service, depending on the circumstances and insurance rules.
Before scheduling, ask your insurer:
"If my screening test is positive, will the follow-up colonoscopy be covered as preventive screening or diagnostic care?"
This can help you understand potential cost-sharing before testing.
Does Medicare Cover Colorectal Cancer Screening?
Yes.
Medicare covers several colorectal cancer screening tests for eligible beneficiaries.
Coverage can include:
screening colonoscopy;
stool blood testing;
stool DNA testing;
and other Medicare-covered screening methods under specified conditions.
The frequency and eligibility requirements depend on the particular test.
Medicare also distinguishes screening services from diagnostic services.
If a screening test produces an abnormal result, follow-up services can be subject to different cost-sharing rules.
Medicare beneficiaries should verify the current coverage rules for the specific test they are considering.
What Is the Cheapest Colorectal Cancer Screening Test?
There is no universal cheapest test for everyone because insurance coverage and local prices vary.
For uninsured patients, an annual FIT can be less expensive and easier to access than colonoscopy.
But price should not be the only consideration.
A test that requires regular repetition and follow-up should be evaluated as a complete screening strategy.
For example:
FIT
→ annual testing
→ positive result
→ colonoscopy
versus:
Colonoscopy
→ one examination every 10 years for average-risk screening when appropriate
The initial price is only one part of the overall cost.
How Much Does a Colonoscopy Cost Without Insurance?
The cost of a colonoscopy without insurance varies substantially across the United States.
The total price can depend on:
geographic location;
hospital versus ambulatory surgery center;
physician fees;
anesthesia;
pathology;
facility fees;
whether polyps are removed;
and whether the procedure is classified as screening or diagnostic.
For uninsured patients, asking for a single "colonoscopy price" may therefore produce an incomplete answer.
Ask for the total self-pay price, including:
facility;
physician;
anesthesia or sedation;
pathology if applicable;
and polyp removal or biopsy charges.
A future article in this cluster will examine colonoscopy costs in more detail.
What Is the Difference Between Screening and Diagnostic Colonoscopy?
This distinction can affect insurance coverage and cost.
A screening colonoscopy is performed as preventive screening in someone without symptoms or a known abnormality requiring evaluation.
A diagnostic colonoscopy is performed to investigate a symptom, abnormal screening result or other medical concern.
The procedure itself may look similar, but the reason for performing it can affect how it is billed and how insurance processes the claim.
This is why a patient should ask the healthcare provider:
"Is this colonoscopy being scheduled as a screening examination or as follow-up to an abnormal screening test?"
What Happens During a Colonoscopy?
A colonoscopy uses a flexible instrument with a camera to examine the inside of the colon and rectum.
Before the procedure, patients generally need bowel preparation to clear the colon.
During the examination, the clinician can:
inspect the colon lining;
identify polyps;
remove many polyps;
and take tissue samples when necessary.
Sedation is commonly used.
Afterward, the patient may need someone else to drive them home if sedation was administered.
The exact preparation and sedation approach varies by facility and patient.
Can Polyps Be Removed During a Colonoscopy?
Yes.
One major advantage of colonoscopy is that doctors can often remove polyps during the same procedure.
A polyp is not automatically cancer.
Some polyps are benign, while certain types can become cancer over time.
Removing precancerous polyps can reduce the chance that they progress to colorectal cancer.
The removed tissue can be sent to a laboratory for pathology.
The pathology results can then influence the timing of the next colonoscopy.
Is Colorectal Cancer Preventable?
Some colorectal cancers can potentially be prevented through screening because precancerous polyps can be detected and removed before they become cancer.
Screening can also detect cancer at an earlier stage, when treatment may be more effective.
However, screening cannot prevent every colorectal cancer.
Risk also depends on:
age;
family history;
inherited conditions;
inflammatory bowel disease;
lifestyle factors;
and other biological factors.
Screening is therefore an important prevention and early-detection strategy, not a guarantee against cancer.
What If You Are Younger Than 45?
Routine average-risk screening generally begins at age 45.
But younger adults should not ignore concerning symptoms.
If someone under 45 develops symptoms such as rectal bleeding, unexplained iron-deficiency anemia, persistent bowel changes or unexplained weight loss, they should talk with a healthcare professional.
The age-based screening recommendation is not a rule saying colorectal cancer cannot occur before 45.
It is a recommendation for routine screening of people at average risk without concerning symptoms.
Colorectal Cancer Screening: Quick Guide for 2026
| Screening test | Typical interval for average-risk adults |
|---|---|
| FIT | Every year |
| Multitarget stool DNA | Every 3 years |
| Multitarget stool RNA | Every 3 years |
| Colonoscopy | Every 10 years |
| CT colonography | Every 5 years |
| Flexible sigmoidoscopy | Every 5 years |
| Certain blood-based tests | According to the specific test and current recommendation |
A positive stool-based or blood-based screening result generally requires follow-up colonoscopy.
Screening intervals can differ for people with higher-than-average risk.
Which Colorectal Cancer Screening Test Should You Choose?
There are several practical questions to consider.
Choose a test you are willing to complete
A theoretically excellent test is not useful if you never undergo it.
Consider how often you want testing
FIT is performed annually.
Colonoscopy is generally performed every 10 years for average-risk screening when appropriate.
Consider whether you are willing to undergo bowel preparation
Colonoscopy requires bowel preparation.
Stool-based tests generally do not require the same preparation.
Consider follow-up
If a stool or blood test is positive, you will generally need colonoscopy.
Consider your risk level
Average-risk screening options are not necessarily appropriate for people with previous colorectal cancer, certain polyps, inflammatory bowel disease or inherited syndromes.
Questions to Ask Your Doctor About Colorectal Cancer Screening
Before choosing a test, ask:
Am I average risk for colorectal cancer?
Should I start screening now?
Which screening test is appropriate for me?
Do I have a family history that changes the recommendation?
Have I ever had polyps?
Should I have a colonoscopy instead of a stool test?
If I choose FIT or another stool test, how often do I need it?
What happens if the result is positive?
Will my insurance cover the screening test?
What would I pay for follow-up colonoscopy if the test is positive?
The Bottom Line
For adults at average risk in the United States, colorectal cancer screening generally begins at age 45.
There is no single screening test that is right for everyone.
Options include:
annual FIT;
multitarget stool DNA testing every three years;
multitarget stool RNA testing every three years;
colonoscopy every 10 years;
CT colonography every five years;
flexible sigmoidoscopy at recommended intervals;
and certain blood-based screening tests.
The most important rule is to complete the entire screening pathway.
If you choose a stool-based or blood-based test and the result is positive, you generally need a follow-up colonoscopy.
People with symptoms, a personal history of colorectal cancer or certain polyps, inflammatory bowel disease, inherited cancer syndromes or significant family history may need a different screening strategy.
If you are 45 or older and have never been screened, the most useful next step is to discuss which evidence-based screening option you are most likely to complete.
Official Medical Sources
This article was reviewed against:
American Cancer Society
U.S. Preventive Services Task Force
Centers for Disease Control and Prevention
National Cancer Institute
Medicare.gov
U.S. Food and Drug Administration
Key points reviewed:
Average-risk colorectal cancer screening begins at age 45 under current ACS guidance.
Multiple stool-based, visual and blood-based screening options are available.
Positive non-colonoscopy screening tests require follow-up colonoscopy.
ACS recommends completing follow-up colonoscopy after a positive non-colonoscopy test, preferably within six months.
Screening recommendations differ for people at increased risk.
Last reviewed for source accuracy: October 2026.
Medical disclaimer: This article is for general educational purposes only and is not a substitute for professional medical advice, diagnosis or treatment. Screening recommendations can change, and people with symptoms or higher-than-average colorectal cancer risk may need individualized evaluation.