How Often Should I Have a Colonoscopy?

Read on for updated options in colorectal cancer detection

Doctor holding sign: Colonoscopy

Did you know that colon cancer is the third most commonly diagnosed cancer in both men and women? Thankfully, more Americans are getting the message about the importance of screening. Among 19 million adults were scheduled for a colonoscopy in 2019. But that's not enough, experts say. 

“The whole point of cancer screening is to find problems early, when there’s more we can do for patients to keep them healthy, active, and alive,” says Dr. Robert F. Raspa, a spokesperson for the American Academy of Family Physicians.

To get more of us checked out, guidelines have been updated and (yay!) colonoscopies aren’t the only option. Here’s a look at the various testing options that might be right for you, and when you should have them performed.

Start Screening at Age 50
For most of us, screening should begin at age 50 and continue into your mid-70s. Some cancer experts encourage African-Americans to start getting screenings at age 45. In addition, anyone with a personal history of a chronic inflammatory bowel disease, such as Crohn’s disease or ulcerative colitis, or a family history of colorectal cancer will need to get checked out sooner—and more often. After age 75, your doctor will consider your overall health and prior screening results to determine if more tests are necessary. If you’ve been putting off a recommended colonoscopy, Raspa suggests letting your doctor know your concerns and asking if you might be a good candidate for one of the less invasive screening tests.

New Options
To put things bluntly, our poop can tell doctors a lot about our colon health. Some of the following stool-based screening tests can detect both cancer and harmful polyps in all areas of the colon:

  • A fecal occult blood test, which is recommended every year, examines a stool sample for hidden blood; that can be an early warning sign of colorectal disease.
  • A fecal immunochemical test (FIT), to be done every year, only covers the lower intestine.
  • An FIT with a stool DNA test is done every one or every three years, depending on individual factors. It examines stool health and looks for certain genetic changes that are sometimes found in colon cancer cells.

Many times, however, your doctor wants a close-up look at your colon. A colonoscopy, which gives doctors a complete view of your bowel and is repeated every 10 years, remains the gold standard, but there are other direct visualization screening tests available:

  • Computed tomographic colonography is recommended every five years. It is often called a virtual colonoscopy because it’s less invasive (a small flexible tube is inserted through the rectum, and air is pumped through it to make viewing the colon easier).
  • Flexible sigmoidoscopy is also recommended every five years. A sigmoidoscopy is similar to a colonoscopy: Both involve inserting a thin, flexible tube with a camera on the end into the colon, but a flexible sigmoidoscopy doesn’t probe the complete colon.
  • Flexible sigmoidoscopy with an FIT test is recommended with the sigmoidoscopy being done every 10 years and the FIT every year.