This was originally posted on June 18, 2020 – Updated on May 7, 2025
Colorectal cancer is the second leading cause of cancer-related deaths in the United States. Each year, tens of thousands of lives are lost to a disease that is often preventable. The good news is that colorectal cancer prevention is possible through timely and appropriate screening. When detected in its early stages, the five-year survival rate for colorectal cancer exceeds 90%.
Despite this, many individuals delay or avoid colorectal cancer screening, either due to uncertainty about the available tests or lack of symptoms. However, colorectal cancer often develops silently over time, beginning as benign polyps that can grow and become cancerous if left untreated. Removing these polyps through a preventive colonoscopy significantly reduces the risk of cancer.
Who Should Be Screened for Colorectal Cancer?
Screening guidelines recommend that adults between the ages of 45 and 75 undergo regular colorectal cancer screening, even if no symptoms are present. However, those with increased risk may need to begin screening earlier or undergo testing more frequently.
High-risk groups include individuals with:
- A personal history of colorectal polyps or cancer
- Inflammatory bowel conditions such as Crohn’s disease or ulcerative colitis
- A family history of colorectal cancer or advanced polyps
- Known genetic syndromes like Lynch syndrome or familial adenomatous polyposis
Screening is not one-size-fits-all. Risk factors and medical history help determine which test is most appropriate and when to begin screening.
Common Screening Methods for Colorectal Cancer
Several tests are available to detect colorectal cancer and precancerous polyps. Each option has benefits and limitations.
Colonoscopy
A preventive colonoscopy is a comprehensive procedure that examines the entire colon using a flexible, lighted tube called a colonoscope. It is the only screening method that allows for the detection and removal of polyps in a single session. For this reason, colonoscopy is considered the gold standard for colorectal cancer screening and prevention.
Fecal Immunochemical Test (FIT)
FIT is a non-invasive stool-based test that checks for hidden blood, which may be an early sign of polyps or cancer. It is typically performed once a year and requires follow-up colonoscopy if the result is positive.
CT Colonography (Virtual Colonoscopy)
This imaging test uses a CT scanner to generate a detailed, 3D view of the colon. It is less invasive than traditional colonoscopy but does not allow for polyp removal during the procedure. Abnormal findings still require a traditional colonoscopy.
Cologuard
This at-home stool test looks for blood and abnormal DNA that may indicate cancer or precancerous growths. Although convenient, Cologuard has a higher rate of false positives and missed polyps when compared to colonoscopy.
Why Colonoscopy is the Preferred Option
While several screening options are available, colonoscopy stands out for both its diagnostic precision and its ability to prevent cancer in a single procedure. Most colorectal cancers begin as polyps, small growths in the colon that can become cancerous over time. A preventive colonoscopy not only detects these polyps but removes them during the same procedure, significantly lowering the risk of future cancer development.
Unlike stool-based tests such as FIT or Cologuard, which only detect signs of existing cancer or bleeding, colonoscopy offers a proactive approach. Positive results from these non-invasive tests still require a follow-up colonoscopy for confirmation and treatment, adding time, cost, and complexity to the process.
Another advantage is the screening interval. Stool tests typically need to be repeated annually or every few years, while individuals with normal colonoscopy results may not need another screening for up to 10 years, making it a more efficient and long-term solution for colorectal cancer prevention.
Understanding Insurance and Cost Implications
While most insurance plans, including Medicare, fully cover preventive colorectal cancer screening, coverage may vary when follow-up testing is needed. For example, if a patient receives a positive result from a FIT or Cologuard test, the follow-up colonoscopy is often categorized as diagnostic rather than preventive. This can result in unexpected out-of-pocket costs.
It is important to:
- Confirm screening benefits with the insurance provider
- Ask about coverage for follow-up colonoscopies in the event of a positive result
- Consider long-term value and cost-effectiveness when selecting a screening method
Approximately 1 in 6 people who use Cologuard will receive a positive result. Of those, nearly 45% are found to be false positives after follow-up colonoscopy. Understanding potential insurance implications helps avoid financial surprises while staying on track with screening goals.
Make Screening a Priority With Northeast Digestive
Colorectal cancer often develops without symptoms but with early detection, it’s one of the most preventable and treatable cancers. Regular screening, especially through preventive colonoscopy, plays a critical role in protecting long-term health by identifying and removing precancerous polyps before they progress.
At Northeast Digestive, our board-certified gastroenterologists provide expert care and personalized screening recommendations based on your age, risk factors, and medical history. Through programs like Open Access, eligible patients can skip the referral step and schedule a screening directly—saving time while prioritizing prevention. Contact us today to schedule your colorectal cancer screening.
