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Colorectal cancer screening tests: Colonoscopy vs. Cologuard

Turning 50 involves a rite of passage most of us avoid talking about: the dreaded colonoscopy. As a widely used exam that detects changes and abnormalities in the large intestine and rectum, colonoscopies get a bad rap, but screenings for colorectal cancer can save lives. The good news for newly minted quinquagenarians (people ages 50 to 59) is that now you may be able to take an at-home colon cancer test called Cologuard® instead of getting a colonoscopy, as long as you meet a few requirements. But first, let’s cover a few basics.

Colorectal cancer 101

Colon cancer and rectal cancer are often referred to together as colorectal cancer. The colon is the final part of the digestive tract, while the rectum is the last several inches of the large intestine. The disease is usually preventable, but according to the Mayo Clinic, colorectal cancer is the second-leading cause of cancer-related deaths among adults in the U.S., partly because one in three people who should get screened don’t.

With proper screening and treatment, it’s possible to survive colorectal cancer. In fact, there are more than a million survivors of colorectal cancer in the U.S. today.

Most adults should get screened for colorectal cancer starting at age 50

Colorectal cancer usually begins as small growths called polyps. (The medical term is adenomatous polyps.) Over time, polyps can become cancerous, but even then they don’t always cause symptoms.

You can have polyps or colorectal cancer without knowing it. That’s why the U.S. Preventive Services Task Force recommends screening for colorectal cancer starting at age 50—for most Americans—and continuing until age 75. Screening is so important because colorectal cancer is easier to treat when it’s found early, before symptoms develop.

Learn to spot the symptoms of colorectal cancer

Many people with colorectal cancer have no signs or symptoms, particularly early on. In some cases, however, colorectal cancer may cause symptoms, including:

  • Diarrhea, constipation, or a change in the consistency of your stool that lasts four weeks or longer
  • Blood in or on your stool
  • Stomach pain, aches, or cramps that don’t go away
  • A feeling that your bowel isn’t emptying completely
  • Unexplained weight loss

If you have any of these signs or symptoms, talk to your doctor. It doesn’t necessarily mean you have cancer. Only a doctor can determine what’s causing your symptoms.

Control your risk factors for colorectal cancer

It’s not always clear what causes cancer of the colon or rectum, but several risk factors may increase your chances of developing colorectal cancer. You can control some risk factors, while others can’t be changed.


Colorectal cancer risk factors you can change:

Weight. Being overweight or obese can increase your risk of developing colorectal cancer. Having a larger waistline also raises the risk, especially in men. If you’re overweight, ask your doctor about healthy ways to lose weight.

Physical inactivity. Living a sedentary lifestyle can lead to a greater chance of developing colorectal cancer. Being active can help lower your risk, but check with your doctor before starting a new exercise program.

Diet. Colorectal cancer may be associated with low-fiber, high-fat diets. A diet high in red meat and processed meats (hot dogs and some lunch meats) may also raise your risk. Eating a healthy, high-fiber diet may lower your risk of developing the disease.

Smoking. People who have smoked tobacco for a long time have a higher risk of developing colorectal cancer. Talk to your doctor about effective ways to quit smoking.

Alcohol. Colorectal cancer may be linked to heavy alcohol use. If you choose to drink, limit yourself to no more than two drinks a day for men and one drink a day for women.


Colorectal cancer risk factors you can’t change:

Age. Anyone can get colorectal cancer, but it’s more common after age 50.

Family history. If your parent, brother, sister, or child developed colorectal cancer, you’re at an increased risk. A family history of polyps—the growths in the colon that can become cancerous—also increases your risk. Your doctor may recommend that you should start screening for the disease before age 45.

Inflammatory intestinal conditions. Inflammatory bowel disease (IBD), ulcerative colitis, and Crohn’s disease all increase your risk of colorectal cancer. However, irritable bowel syndrome (IBS) is not associated with colorectal cancer.

Type 2 diabetes. People with type 2 diabetes have an increased risk of colorectal cancer.

Racial and ethnic background. African Americans and Ashkenazi Jews of Eastern European descent have higher rates of the disease. Researchers are still studying the reasons for this.

Genetic syndromes. A very small percentage of people inherit gene mutations that have been linked with colorectal cancer.

Ask your doctor about what colorectal cancer screening test is right for you

Screening options for colorectal cancer include tests that look for signs of cancer in the stool and visual exams of the colon and rectum. Talk with your doctor about which option may be best for you and check with your health insurance provider about which tests are covered.

Colorectal cancer screening tests include:


Is Cologuard right for you?

Cologuard is a new type of at-home colon cancer test that the FDA approved in recent years. Available by prescription, it’s ideal for some people who are looking for an alternative to a colonoscopy, which requires bowel preparation, sedation, and time off from work. One advantage of Cologuard is that it doesn’t require any special diets, bowel prep, laxatives, or enemas. The patient simply collects a stool sample at home and mails it to a lab for analysis.

Cologuard is not right for everyone. And, some people will need to follow it up with a colonoscopy. In order to qualify for Cologuard, you must:

  • Be age 50 to 85 years
  • Have no symptoms of colon cancer
  • Have no history of IBD, Crohn’s disease, or ulcerative colitis
  • Have no personal or family history of pre-cancerous polyps or colon cancer
  • Have no family history of genetic syndromes linked with colorectal cancer
Lower your risk for colorectal cancer with preventive screenings

Whether or not Cologuard is right for you, be sure to ask your doctor about getting tested for colorectal cancer. No one looks forward to preparing for or getting a colonoscopy, but it’s a small price to pay for a test that could end up saving your life.