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Vital Signs: When, how and why to get screened for colorectal cancer

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Colorectal cancer is the third-most-common cancer in both men and women in the United States and is the second-most-common cause of death from cancer, behind only lung cancer. Because most cases of colon cancer take years to develop, we have an opportunity with regular screenings to not only catch cancer at an early, curable stage, but with colonoscopy, we can also remove the precancerous polyps and prevent cancer from developing.

As we commemorate Colorectal Cancer Awareness Month, I want to make sure everyone is aware of the latest guidelines on colorectal cancer screening. In 2021, the U.S. Preventive Services Task Force updated its recommendations on colon cancer screening to offer screening at age 45 for all average-risk adults. Part of the rationale to lower the age for screening is that despite improvements in the overall trends of colon cancer cases and deaths over the past few decades, we have seen as much as a 15% increase in the number of colorectal cancer cases in adults ages 40 to 49.

Your screening optionsWhile we say that the best screening option is whatever test has the highest likelihood of a patient completing it, there are two major testing approaches most often used in the U.S. that are supported by the highest-quality evidence: colonoscopy and stool-based testing.

The benefit of a colonoscopy is that it is both diagnostic and therapeutic. This means that whatever we find during the screening, such as precancerous polyps, we remove at the time of screening.

Stool-based testing strategies, such as an annual fecal immunochemical test (FIT) or a multitarget stool DNA test every three years, are also highly effective strategies. However, stool-based testing is considered a two-step strategy, because any positive test still requires a colonoscopy for follow up to remove any polyps. Less commonly used screening tests include flexible sigmoidoscopy, CT colonography or colon video capsule. These tests do not have as much evidence supporting their use and should be reserved for patients unable or unwilling to undergo colonoscopy or annual FIT testing.

When deciding which screening approach to use, patients should also consider their overall risk for colon cancer. Stool-based testing should only be used by “average-risk” patients, so anyone at higher risk for colon cancer based on a personal history of colon polyps, a family history of colon cancer or an underlying medical condition such as inflammatory bowel disease should not use a stool-based screening option and should instead undergo a colonoscopy. Depending on a patient’s risk factor, the age at which to start screening could be younger than 45, and this decision is best made with the input of a primary care physician or a gastroenterologist.

How UVa Cancer

Center can helpThe UVa Cancer Center — one of just 52 National Cancer Institute-designated comprehensive cancer centers in the U.S. and the only one in Virginia — offers exceptional screening and care for colorectal cancer. UVa provides the full range of colorectal cancer screening options for patients, including high-screening colonoscopy to patients, as well as diagnostic colonoscopy for patients with a positive stool test. Our gastroenterologists perform high-quality colonoscopy and offer advanced endoscopic options for patients with complicated adenomas.

For patients who need surgical care for colorectal cancer, U.S. News & World Report rates colon cancer surgery at UVa as “high performing” – the best possible rating. To learn more about colorectal cancer screening and treatment options at UVa, visit

Dr. Esteban Figueroa is a gastroenterologist at UVa Health.


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