Cancer; Digestive

Colonoscopy and alternative screenings key to detecting colon cancer

Cancer; Digestive

Colonoscopies are recommended for people beginning at age 45 in an effort to catch colon cancer early in younger patients.

Colonoscopy is the gold standard in colon cancer screening and is recommended beginning at age 45 as cancer rates continue to climb among middle-aged adults. But only 1 in 5 people in the 45-49 age group are getting screened, according to the American Cancer Society.

While colorectal cancer rates overall have been declining since the mid-1980s, they have been rising 1% to 2% a year since the mid-1990s among people younger than 55, the American Cancer Society has found. People younger than 55 now make up about 20% of all diagnosed colorectal cancer cases. That trend that was underscored with the 2020 death of Chadwick Boseman, the 43-year-old “Black Panther” star who battled colon cancer for four years.

The latest statistics show colorectal cancer is the leading cause of cancer deaths among men younger than 50 and the second leading cause of cancer deaths among women in that age group.

In May 2021, the U.S. Preventative Services Task Force (USPSTF) lowered the recommended age to start colorectal cancer screening from 50 to 45. The hope is that the new guidelines will help raise awareness about the importance of colonoscopies, which are vital to preventing more cancers and catching the disease early in younger patients.

But screening guidelines only work if people follow them.

It’s estimated that 26% of eligible adults in the U.S. have never been screened for colorectal cancer, and 31% are not up to date with their screenings. Multiple factors contribute to those numbers – everything from anxiety over getting a colonoscopy to confusion about insurance coverage for the procedure to limitations on transportation and time off work.

Fortunately, colonoscopy has come a long way in the last few years. The prep drink is gentler (and tastes better, too!), and the screening exam is painless and quicker than you might expect.

Most insurance companies and Medicare cover colonoscopy screenings, and the USPSTF’s new guidelines lowering the age to 45 should give more people access to this potentially life-saving procedure.

What’s more, there are alternative screenings for people who can’t or won’t get a colonoscopy.

Let’s review what types of colorectal cancer screening are available and dispel a few concerns that many people have about colonoscopies.

Colonoscopies and alternative screening options

While there are some differences between colorectal screening options, the most important thing is that you get screened. Depending on your comfort and overall cancer risk, you may choose from a range of options.

One of the benefits of colonoscopy is that if the doctors find a polyp during the procedure, they will remove it and have it biopsied.


  • Traditional: This gold-standard colorectal cancer screening allows doctors to detect and remove polyps – suspicious tissue growths in the colon – during the same procedure. You will be asleep during the exam. The doctor will insert a thin tube with a camera attached into your rectum to examine your entire colon.
  • Virtual: The doctor will use CT imaging to examine your colon for suspicious polyps. You will be awake since the imaging occurs outside your body. If polyps are detected, your doctor may recommend a traditional colonoscopy to remove them.
  • Flexible sigmoidoscopy: This exam looks at just the rectum and lower part of the colon. You will be asleep during the exam, which is performed similarly to colonoscopy.

If the doctor finds a polyp during a colonoscopy, they can remove it on the spot. Having a polyp doesn’t necessarily mean you have cancer or are at increased risk for developing it. When we remove polyps, we have them biopsied to determine whether they might have developed into cancer, and whether you might need additional testing or procedures to protect you against cancer.

At UT Southwestern, gastroenterologists and colorectal surgeons perform our patients’ colonoscopies. We are part of a multidisciplinary team that includes imaging experts and oncologists – we will get you quick, effective next steps if a polyp looks suspicious or a biopsy comes back positive for cancer.

Modern colonoscopy: Easier, gentler

The two most common questions people have about getting a traditional colonoscopy are, “How awful is the bowel prep?” and “Will I be awake and feel anything during the procedure?”

Let us put your mind at ease. The bowel prep is much more tolerable than it used to be. Modern laxative solutions (usually liquid) are low volume with a tolerable flavor. It’s not champagne, but it's not the disgusting drink it used to be.

Generally considered the most difficult part of any colonoscopy, bowel prep is important because it empties your colon, making it easier for your doctor to spot polyps.

Your doctor will prescribe the best type of bowel prep for you. You will likely need to avoid high-fiber foods for a few days and limit your diet to clear liquids the night or morning before the procedure.

You will be asleep during a traditional colonoscopy, which takes anywhere from 30 to 60 minutes. We use carbon dioxide to inflate the colon, which reduces cramping after the screening. Most patients won’t remember the procedure or experience discomfort afterward.

You will stay in a recovery room for about 30 minutes to allow the sedation to wear off, and you’ll need to arrange for someone to drive you home.

Alternative screening options

  • Fecal occult blood test (FOBT): This at-home test looks for hidden blood in the stool. Following the package directions, you will send a sample of your stool to a lab for analysis. You will need to clear your bowel prior to this test, per the doctor’s instructions.
  • Fecal immunochemical tests (FIT): The at-home FIT test is similar to FOBT, without the need to clear your bowel in advance.
  • Cologuard (stool DNA test): Cologuard looks for cancer-related DNA markers and hidden blood in your stool. This test can be done at home in a similar fashion as the FIT test.

Alternative options are designed for patients at average risk for colon cancer. If you are at high risk but uncertain about colonoscopy, talk with your doctor about the best alternative for you.

Getting a positive test result from an alternative screening option doesn’t automatically mean you have cancer. If you get a positive result, you’ll need to have a colonoscopy to remove any polyps and get a true diagnosis.

Colorectal cancer Q&A

What does ‘average risk of colon cancer’ mean?

Average risk of getting colorectal cancer means people who don’t have a:

  • Personal or family history of colorectal cancer or precancerous polyps
  • Genetic disorder that raises their risk
  • Diagnosis of inflammatory bowel disease
Who is at increased risk of colon cancer?

All adults age 45 and older should be screened for colorectal cancer. Those who are at increased risk includes those who have a:

  • Personal or family history of colorectal cancer or precancerous polyps
  • Genetic disorder that raises their risk
  • Diagnosis of inflammatory bowel disease

Getting screened is particularly important for African-American adults, who are 20 percent more likely to develop colon cancer and nearly 40 percent more likely to die from it. Reasons why are complex and may include differences in access to health care and risk factors such as obesity, tobacco use, and lower physical activity.

Talk with your parents and family members about their history of cancer and precancerous polyps. Share this information with your doctor to determine the best screening strategy for you.

Why are younger people developing colon cancer?

Lifestyle changes can reduce your risk of colorectal cancer. These include managing your weight, eating a healthy diet, staying physically active, and limiting alcohol consumption.

Colon cancer has been associated with a range of risk factors. Some research suggests that eating or drinking too much high-fructose corn syrup can increase cancer growth in patients who are predisposed to developing the disease.

What are the symptoms of colon cancer?

Colon cancer often doesn’t present with symptoms until the disease gets serious. However, some early symptoms can include:

  • Abdominal pain
  • Blood in the stool
  • Constipation
  • Diarrhea
  • Decreased appetite
  • Weight loss

Talk with a doctor if you experience colon cancer symptoms. Catching the disease early can give you the best chance at positive outcomes.

How often do I need colorectal cancer screening?

If you have a family history of colon cancer, talk with your doctor about when to get your first colonoscopy. We often recommend it be 10 years before the earliest onset of anybody in the family. So, if a parent was diagnosed at 51, you should start getting screened at 41.

The frequency of colonoscopies will be determined based on the findings of each patient’s results from the procedure. For example, an individual who has no polyps may not need another colonoscopy for 10 years, dependent on their age and family history, while someone who has a large number of precancerous polyps removed might be asked to return for a repeat colonoscopy in three years.

If you choose a screening alternative instead of colonoscopy, you may need to repeat screening every three to five years. Talk with your doctor about the best cadence based on your personal risk factors.

Related reading: 8 common myths about colon cancer

The best way to protect yourself from colorectal cancer is to get regular screenings. To visit with a doctor or schedule a colorectal cancer screening, call 214-645-8300 or request an appointment online.