Colonoscopy vs. At-home Screening: Which Is Right for You?

Calendar showing colonoscopy appointment

April 05, 2022

Clinical Contributors to this story:
Rosario Ligresti, M.D.
Since the 1990s, the rate of colorectal cancer has more than doubled among adults younger than 50, according to the National Cancer Institute. Colon cancer is one of the leading causes of cancer deaths for men and women in the United States, and it is recommended that screening begin at age 45, or sooner if you have symptoms, heightened risk due to family history or genetics, or other predisposing conditions. 

Screening Options

A traditional colonoscopy is an outpatient exam, typically performed every 10 years, used to discover potential digestive disease. Your doctor will use a long flexible tube with a small camera to visually examine the colon. Images are taken, sometimes along with tissue samples for biopsy.

“Although a colonoscopy is considered the ‘gold standard’ for colon cancer screening, it’s one of those things that many people dread,” says Rosario Ligresti, M.D., chief, Division of Gastroenterology at Hackensack University Medical Center. “For people at higher risk of colorectal disease, though, this is still the best option.”

Those at higher-risk include:

  • An individual with a family history of colon cancer (any first-degree relative under 60 years of age who has been diagnosed)
  • An individual who has had precancerous polyps or predisposing diseases, such as inflammatory bowel disease (IBD)

However, for average- to low-risk patients, at-home colorectal screening can be an option. There are two at-home tests available: 

  • Home fecal immunochemical tests, which should be performed annually
  • Fecal occult blood testing or multitarget stool DNA tests, such as Cologuard®, which should be performed every three years

What to Know About At-home Screening

An at-home exam must be prescribed by your primary care doctor or gastroenterologist. Using a lab-provided kit, at home you will collect a stool sample, then mail it back to the testing company for analysis. Test results from your laboratory sample are generally received by your doctor within a few weeks. If there is any abnormality in your results, a follow-up colonoscopy may be required. 

Dr. Ligresti offers a few things to keep in mind when it comes to at-home tests: 

  • At-home tests are not as sensitive to the detection of precancerous polyps in comparison to in-office screening.
  • At-home tests display false positives in about 14 percent of cases.
  • At-home tests must be performed more frequently than traditional colonoscopy. 

Watch Dr. Ligresti share everything you need to know about colonoscopy prep:


Next Steps & Resources:


The material provided through HealthU is intended to be used as general information only and should not replace the advice of your physician. Always consult your physician for individual care.

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