Colon Cancer Tests | EvidenceMD

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The best test is one that you are willing to do. The world's leading experts state that the best colorectal screening test is one that an asymptomatic patient at average risk of colorectal cancer is willing to complete, as both invasive and non-invasive tests save lives by reducing cancer deaths…

Screening Tests

Screening tests can find colorectal cancer early when treatment works best. Colorectal cancer almost always develops from precancerous polyps (abnormal growths) in the colon or rectum. Certain screening tests can find precancerous polyps so that they can be removed before they turn into cancer. Regular screening, beginning at age 45, is the key to preventing colorectal cancer. There are both invasive and non-invasive colon cancer screening tests.

Expert Recommendations

The world's leading experts state that the best colorectal screening test is one that an asymptomatic patient at average risk of colorectal cancer is willing to complete, as both invasive and non-invasive tests save lives by reducing cancer deaths. Colorectal cancer screening in adults aged 45 to 49 reportedly has a moderate net benefit; in adults aged 50 to 75 a substantial net benefit; and in adults age 76 to 85 a small net benefit. After age 85, screening should be discontinued. Patients should consult with their doctors to gauge their risk of cancer and to select a test.

Sourced from CDC, USPSTF and other authorities

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Colonoscopy Every 10 years

Patient Summary: The doctor puts a thin, flexible, lighted tube into a patient's rectum to detect polyps or cancer in the entire colon. During the test, the doctor can find and remove most polyps and some cancers. This test is also used as a follow-up test if anything unusual is found during one of the other screening tests.

Professional Summary: The doctor puts a thin, flexible, lighted tube into a patient's rectum to detect polyps or cancer in the entire colon. During the test, the doctor can find and remove most polyps and some cancers. This test is also used as a follow-up test if anything unusual is found during one of the other screening tests.

Sourced from:

CDC, Colorectal Cancer Screening Tests, 2020

Success Rate for Colonoscopy Every 10 years

Patient Summary: Colonoscopy every 10 years detects colorectal cancer 95% of the time. For every 1,000 patients who had a colonoscopy every 10 years, 28 avoided colorectal cancer death because they started taking the test at age 45.

Professional Summary: Colonoscopy every 10 years detects colorectal cancer 95% of the time. For every 1,000 patients who had a colonoscopy every 10 years, 28 avoided colorectal cancer death because they started taking the test at age 45.

Sourced from:

US Preventive Services Task Force, Colorectal Cancer: Screening, "Figure 1, Table C. Benefits of Colorectal Cancer Screening"
“Evaluating the Benefits and Harms of Colorectal Cancer Screening Strategies: A Collaborative Modeling Approach”, Table 4, AHRQ Publication No. 14-05203-EF-2, Zauber et al, 2015

Risk of Complications for Colonoscopy Every 10 years

Patient Summary: For every 1,000 patients who had a colonoscopy every 10 years, 16 suffered gastrointestinal or cardiovascular events due to the screening test and follow-up colonoscopies.

Professional Summary: For every 1,000 patients who had a colonoscopy every 10 years, 16 suffered gastrointestinal or cardiovascular events due to the screening test and follow-up colonoscopies. Gastrointestinal events included perforations, bleeding, transfusions, paralytic ileus, nausea and vomiting, dehydration, and abdominal pain. Cardiovascular events included myocardial infarction, angina, arrhythmia, congestive heart failure, cardiac or respiratory arrest, syncope, hypotension, and shock.

Sourced from:

US Preventive Services Task Force, Colorectal Cancer: Screening, "Figure 2, Table A. Harms and Burden of Colorectal Cancer Screening"

Risk of Death for Colonoscopy Every 10 years

Patient Summary: Around 7 in 100,000 patients will die due to a colonoscopy.

Professional Summary: The rate of death for colonoscopy is 0.007%. Older adults are more likely to suffer serious complications compared with younger adults.

Sourced from:

NIH PubMed, Complications of colonoscopy, Gastrointest Endosc., ASGE Standards of Practice Committee, 2012

Cologuard (FIT-DNA) every year

Patient Summary: The FIT-DNA test combines a fecal immunochemical test (FIT) to detect blood in the stool with a second test to detect altered DNA. The patient collects from a bowel movement and sends the sample to a lab for evaluation.

Professional Summary: This is a composite of tests including molecular assays to test for DNA mutations and an immunochemical assay (FIT) to test for hemoglobin from blood that may have been shed by colorectal lesions. The patient collects from a bowel movement and sends the sample to a lab for evaluation. No bowel preparation, sedation or time off from work or family is required, and there are no medicine or diet restrictions prior to providing the test sample.

Sourced from:

CDC, Colorectal Cancer Screening Tests, 2020

Success Rate for Cologuard (FIT-DNA) every year

Patient Summary: FIT-DNA detects colorectal cancer 92% of the time. For every 1,000 patients who had a FIT-DNA every year, 28 avoided colorectal cancer death because they stated taking the test at age 45.

Professional Summary: FIT-DNA detects colorectal cancer 92% of the time. For every 1,000 patients who had a FIT-DNA every year, 28 avoided colorectal cancer death because they stated taking the test at age 45.

Sourced from:

US Preventive Services Task Force, Colorectal Cancer: Screening, "Figure 1, Table C. Benefits of Colorectal Cancer Screening"
“Evaluating the Benefits and Harms of Colorectal Cancer Screening Strategies: A Collaborative Modeling Approach”, Table 4, AHRQ Publication No. 14-05203-EF-2, Zauber et al, 2015

Risk of Complications for Cologuard (FIT-DNA) every year

Patient Summary: For every 1,000 patients who had a FIT-DNA every year, 13 suffered gastrointestinal or cardiovascular events due to the screening test and follow-up colonoscopies.

Professional Summary: For every 1,000 patients who had a FIT-DNA every year, 13 suffered gastrointestinal or cardiovascular events due to the screening test and follow-up colonoscopies. Gastrointestinal events included perforations, bleeding, transfusions, paralytic ileus, nausea and vomiting, dehydration, and abdominal pain. Cardiovascular events included myocardial infarction, angina, arrhythmia, congestive heart failure, cardiac or respiratory arrest, syncope, hypotension, and shock.

Sourced from:

US Preventive Services Task Force, Colorectal Cancer: Screening, "Figure 2, Table A. Harms and Burden of Colorectal Cancer Screening"

Risk of Death for Cologuard (FIT-DNA) every year

EvidenceMD found no evidence of an association between Cologuard and death.

Cologuard (FIT-DNA) every 3 years

Sourced from:

CDC, Colorectal Cancer Screening Tests, 2020

Success Rate for Cologuard (FIT-DNA) every 3 years

Patient Summary: FIT-DNA detects colorectal cancer 92% of the time. For every 1,000 patients who had a FIT-DNA every 3 years, 25 avoided colorectal cancer death because they stated taking the test at age 45.

Professional Summary: FIT-DNA detects colorectal cancer 92% of the time. For every 1,000 patients who had a FIT-DNA every 3 years, 25 avoided colorectal cancer death because they started taking the test at age 45.

Sourced from:

US Preventive Services Task Force, Colorectal Cancer: Screening, "Figure 1, Table C. Benefits of Colorectal Cancer Screening"
“Evaluating the Benefits and Harms of Colorectal Cancer Screening Strategies: A Collaborative Modeling Approach”, Table 4, AHRQ Publication No. 14-05203-EF-2, Zauber et al, 2015

Risk of Complications for Cologuard (FIT-DNA) every 3 years

Patient Summary: For every 1,000 patients who had a FIT-DNA every 3 years, 10 suffered gastrointestinal or cardiovascular events due to the screening test and follow-up colonoscopies.

Professional Summary: For every 1,000 patients who had a FIT-DNA every 3 years, 10 suffered gastrointestinal or cardiovascular events due to the screening test and follow-up colonoscopies. Gastrointestinal events included perforations, bleeding, transfusions, paralytic ileus, nausea and vomiting, dehydration, and abdominal pain. Cardiovascular events included myocardial infarction, angina, arrhythmia, congestive heart failure, cardiac or respiratory arrest, syncope, hypotension, and shock.

Sourced from:

US Preventive Services Task Force, Colorectal Cancer: Screening, "Figure 2, Table A. Harms and Burden of Colorectal Cancer Screening"

Risk of Death for Cologuard (FIT-DNA) every 3 years

EvidenceMD found no evidence of an association between Cologuard and death.

FIT every year

Patient Summary: The fecal immunochemical test (FIT) detects blood in the stool. The patient uses a stick or a brush to obtain a small amount of stool, then returns the test kit to a doctor or lab.

Professional Summary: FIT is performed on a small stool sample and does not require any medicine or diet restrictions prior to providing the test sample. No bowel preparation, sedation or time off from work or family is required.

Sourced from:

CDC, Colorectal Cancer Screening Tests, 2020

Success Rate for FIT every year

Patient Summary: FIT detects colorectal cancer 74% of the time. For every 1,000 patients who had a FIT every year, 26 avoided colorectal cancer death because they started taking the test at age 45.

Professional Summary: FIT detects colorectal cancer 74% of the time. For every 1,000 patients who had a FIT every year, 26 avoided colorectal cancer death because they started taking the test at age 45.

Sourced from:

US Preventive Services Task Force, Colorectal Cancer: Screening, "Figure 1, Table C. Benefits of Colorectal Cancer Screening"
“Evaluating the Benefits and Harms of Colorectal Cancer Screening Strategies: A Collaborative Modeling Approach”, Table 4, AHRQ Publication No. 14-05203-EF-2, Zauber et al, 2015

Risk of Complications for FIT every year

Patient Summary: For every 1,000 patients who had a FIT every year, 11 suffered gastrointestinal or cardiovascular events due to the screening test and follow-up colonoscopies.

Professional Summary: For every 1,000 patients who had a FIT every year, 11 suffered gastrointestinal or cardiovascular events due to the screening test and follow-up colonoscopies. Gastrointestinal events included perforations, bleeding, transfusions, paralytic ileus, nausea and vomiting, dehydration, and abdominal pain. Cardiovascular events included myocardial infarction, angina, arrhythmia, congestive heart failure, cardiac or respiratory arrest, syncope, hypotension, and shock.

Sourced from:

US Preventive Services Task Force, Colorectal Cancer: Screening, "Figure 2, Table A. Harms and Burden of Colorectal Cancer Screening"

Risk of Death for FIT every year

EvidenceMD found no evidence of an association between FIT and death.

Flexible sigmoidoscopy every 5 years

Patient Summary: The doctor inserts a short, thin, flexible, lighted tube into the patient's rectum to check for polyps or cancer in the lower third of the colon.

Professional Summary: The doctor inserts a short, thin, flexible, lighted tube into the patient's rectum to check for polyps or cancer in the lower third of the colon. Bowel cleaning is required; most people do not require sedation or time off from work or family.

Sourced from:

CDC, Colorectal Cancer Screening Tests, 2020

Success Rate for Flexible sigmoidoscopy every 5 years

Patient Summary: Flexible sigmoidoscopy for that part of the colon within reach of the sigmoidoscope detects colorectal cancer 95% of the time. For every 1,000 patients who had a flexible sigmoidoscopy every 5 years, 24 avoided colorectal cancer death because they started taking the test at age 45.

Professional Summary: Flexible sigmoidoscopy for that part of the colon within reach of the sigmoidoscope detects colorectal cancer 95% of the time. For every 1,000 patients who had a flexible sigmoidoscopy every 5 years, 24 avoided colorectal cancer death because they started taking the test at age 45.

Sourced from:

US Preventive Services Task Force, Colorectal Cancer: Screening, "Figure 1, Table C. Benefits of Colorectal Cancer Screening"
“Evaluating the Benefits and Harms of Colorectal Cancer Screening Strategies: A Collaborative Modeling Approach”, Table 4, AHRQ Publication No. 14-05203-EF-2, Zauber et al, 2015

Risk of Complications for Flexible sigmoidoscopy every 5 years

Patient Summary: For every 1,000 patients who had a flexible sigmoidoscopy every 5 years, 11 suffered gastrointestinal or cardiovascular events due to the screening test and follow-up colonoscopies.

Professional Summary: For every 1,000 patients who had a flexible sigmoidoscopy every 5 years, 11 suffered gastrointestinal or cardiovascular events due to the screening test and follow-up colonoscopies. Gastrointestinal events included perforations, bleeding, transfusions, paralytic ileus, nausea and vomiting, dehydration, and abdominal pain. Cardiovascular events included myocardial infarction, angina, arrhythmia, congestive heart failure, cardiac or respiratory arrest, syncope, hypotension, and shock.

Sourced from:

US Preventive Services Task Force, Colorectal Cancer: Screening, "Figure 2, Table A. Harms and Burden of Colorectal Cancer Screening"

Risk of Death for Flexible sigmoidoscopy every 5 years

EvidenceMD found no evidence of an association between flexible sigmoidoscopy and death.

Flexible sigmoidoscopy every 10 years plus FIT every year

Patient Summary: This is a two-part test. For the sigmoidoscopy, the doctor inserts a short, thin, flexible, lighted tube into the patient's rectum to check for polyps or cancer in the lower third of the colon. For the FIT, the patient uses a stick or a brush to obtain a small amount of stool, then returning the test kit to a doctor or lab to have it checked for blood in the stool.

Professional Summary: For the sigmoidoscopy, the doctor inserts a short, thin, flexible, lighted tube into the patient's rectum to check for polyps or cancer in the lower third of the colon. In addition, the patient is given a fecal immunochemical test (FIT) to detect blood in the stool by having the patient use a stick or a brush to obtain a small amount of stool, then returning the test kit to a doctor or lab.

Sourced from:

CDC, Colorectal Cancer Screening Tests

Success Rate for Flexible sigmoidoscopy every 10 years plus FIT every year

Patient Summary: Flexible sigmoidoscopy for that part of the colon within reach of the sigmoidoscope detects colorectal cancer 95% of the time. For every 1,000 patients who had a flexible sigmoidoscopy every 10 years plus a FIT every year, 28 avoided colorectal cancer death because they started taking the test at age 45.

Professional Summary: Flexible sigmoidoscopy for that part of the colon within reach of the sigmoidoscope detects colorectal cancer 95% of the time. For every 1,000 patients who had a flexible sigmoidoscopy every 10 years plus a FIT every year, 28 avoided colorectal cancer death because they started taking the test at age 45.

Sourced from:

US Preventive Services Task Force, Colorectal Cancer: Screening, "Figure 1, Table C. Benefits of Colorectal Cancer Screening"
“Evaluating the Benefits and Harms of Colorectal Cancer Screening Strategies: A Collaborative Modeling Approach”, Table 4, AHRQ Publication No. 14-05203-EF-2, Zauber et al, 2015

Risk of Complications for Flexible sigmoidoscopy every 10 years plus FIT every year

Patient Summary: For every 1,000 patients who had a flexible sigmoidoscopy every 10 years plus a FIT every year, 13 suffered gastrointestinal or cardiovascular events due to the screening test or follow-up colonoscopies.

Professional Summary: For every 1,000 patients who had a flexible sigmoidoscopy every 10 years plus a FIT every year, 13 suffered gastrointestinal or cardiovascular events due to the screening test or follow-up colonoscopies. Gastrointestinal events included perforations, bleeding, transfusions, paralytic ileus, nausea and vomiting, dehydration, and abdominal pain. Cardiovascular events included myocardial infarction, angina, arrhythmia, congestive heart failure, cardiac or respiratory arrest, syncope, hypotension, and shock.

Sourced from:

US Preventive Services Task Force, Colorectal Cancer: Screening, "Figure 2, Table A. Harms and Burden of Colorectal Cancer Screening"

Risk of Death for Flexible sigmoidoscopy every 10 years plus FIT every year

EvidenceMD found no evidence of an association between flexible sigmoidoscopy and death.

HS-gFOBT every year

Patient Summary: The high-sensitivity guaiac-based fecal occult blood test (HS-gFOBT) uses the chemical guaiac to detect blood in the stool by having the patient use a stick or a brush to obtain a small amount of stool three times, then returning the test kit to a doctor or lab.

Professional Summary: HS-gFOBT is performed on three separate small stool samples and does not require any medicine or diet restrictions prior to providing the test sample, though eliminating red meat for 3 days and restricting vitamin C intake to <250 mg per day are suggested. No bowel preparation, sedation or time off from work or family is required.

Sourced from:

CDC, Colorectal Cancer Screening Tests

Success Rate for HS-gFOBT every year

Patient Summary: gFOBT detects colorectal cancer 70% of the time. For every 1,000 patients who had an HS-gFOBT every year, 24 avoided colorectal cancer death because they started taking the test at age 45.

Professional Summary: gFOBT detects colorectal cancer 70% of the time. For every 1,000 patients who had an HS-gFOBT every year, 24 avoided colorectal cancer death because they started taking the test at age 45.

Sourced from:

US Preventive Services Task Force, Colorectal Cancer: Screening, "Figure 1, Table C. Benefits of Colorectal Cancer Screening"
“Evaluating the Benefits and Harms of Colorectal Cancer Screening Strategies: A Collaborative Modeling Approach”, Table 4, AHRQ Publication No. 14-05203-EF-2, Zauber et al, 2015

Risk of Complications for HS-gFOBT every year

Patient Summary: For every 1,000 patients who had an HS-gFOBT every year, 10 suffered gastrointestinal or cardiovascular events due to the screening test or follow-up colonoscopies.

Professional Summary: For every 1,000 patients who had an HS-gFOBT every year, 10 suffered gastrointestinal or cardiovascular events due to the screening test or follow-up colonoscopies. Gastrointestinal events included perforations, bleeding, transfusions, paralytic ileus, nausea and vomiting, dehydration, and abdominal pain. Cardiovascular events included myocardial infarction, angina, arrhythmia, congestive heart failure, cardiac or respiratory arrest, syncope, hypotension, and shock.

Sourced from:

US Preventive Services Task Force, Colorectal Cancer: Screening, "Figure 2, Table A. Harms and Burden of Colorectal Cancer Screening"

Risk of Death for HS-gFOBT every year

EvidenceMD found no evidence of an association between HS-gFOBT and death.

Virtual (CT) Colonoscopy every 5 years

Patient Summary: The non-invasive virtual colonoscopy, also called a computed tomography (CT) colonography, uses X-rays and computers to produce images of the entire colon which are displayed on a computer screen for the doctor to analyze.

Professional Summary: A computed tomography (CT) colonography, or virtual colonoscopy, uses X-rays and computers to produce images of the entire colon which are displayed on a computer screen for the doctor to analyze.

Sourced from:

CDC, Colorectal Cancer Screening Tests

Success Rate for Virtual (CT) Colonoscopy every 5 years

Patient Summary: Virtual (CT) colonoscopy detects colorectal cancer 84%-96% of the time. For every 1,000 patients who had a Virtual Colonoscopy every 5 years, 26 avoided colorectal cancer death because they started taking the test at age 45.

Professional Summary: Virtual (CT) colonoscopy detects colorectal cancer 84%-96% of the time. For every 1,000 patients who had a Virtual Colonoscopy every 5 years, 26 avoided colorectal cancer death because they started taking the test at age 45.

Sourced from:

US Preventive Services Task Force, Colorectal Cancer: Screening, "Figure 1, Table C. Benefits of Colorectal Cancer Screening"
“Evaluating the Benefits and Harms of Colorectal Cancer Screening Strategies: A Collaborative Modeling Approach”, Table 4, AHRQ Publication No. 14-05203-EF-2, Zauber et al, 2015
NIH PubMed, Colorectal cancer: CT colonography and colonoscopy for detection - -systematic review and meta-analysis, Radiology, Pinkhardt et al, 2011

Risk of Complications for Virtual (CT) Colonoscopy every 5 years

Patient Summary: For every 1,000 patients who had a Virtual Colonoscopy every 5 years, 11 suffered gastrointestinal or cardiovascular events due to the screening test and follow-up colonoscopies.

Professional Summary: For every 1,000 patients who had a Virtual Colonoscopy every 5 years, 10 suffered gastrointestinal or cardiovascular events due to the screening test and follow-up colonoscopies. Gastrointestinal events included perforations, bleeding, transfusions, paralytic ileus, nausea and vomiting, dehydration, and abdominal pain. Cardiovascular events included myocardial infarction, angina, arrhythmia, congestive heart failure, cardiac or respiratory arrest, syncope, hypotension, and shock.

Sourced from:

US Preventive Services Task Force, Colorectal Cancer: Screening, "Figure 2, Table A. Harms and Burden of Colorectal Cancer Screening"

Risk of Death for Virtual (CT) Colonoscopy every 5 years

Patient Summary: No deaths were caused by virtual colonoscopy.

Professional Summary: In a large study, no deaths were reported in symptomatic patients.

Sourced from:

NIH PubMed, Potentially serious adverse events at CT colonography in symptomatic patients: national survey of the United Kingdom, Radiology, Burling et al, 2006

Colon Capsule Endoscopy

Patient Summary: A colon capsule endoscopy requires the patient to swallow a capsule containing wireless cameras that take images as the capsule travels through the colon. It is approved in the U.S. for patients who have had an incomplete colonoscopy.

Professional Summary: A colon capsule endoscopy requires the patient to swallow a capsule containing wireless cameras that take images as the capsule travels through the colon. It is approved in the U.S. for patients who have had an incomplete colonoscopy. Bowel cleansing is required as for a colonoscopy.

Success Rate for Colon Capsule Endoscopy

Patient Summary: A newer colon capsule detected polyps that were 6 millimeters or larger with sensitivity of 84% and specificity of 64%; all invasive carcinomas were detected. Older versions of capsules did not detect all cancers and had varying rates of sensitivity.

Professional Summary: A newer colon capsule detected polyps that were 6 millimeters or larger with sensitivity of 84% and specificity of 64%; all invasive carcinomas were detected. Older versions of capsules to detect significant polyps, defined as either numbering 3 or more or measuring 6 millimeters or larger, had sensitivity of 39%-69% and specificity of around 87%; and in one study, the older colon capsule failed to detect all cancers.

Sourced from:

NIH PubMed, A meta-analysis evaluating the accuracy of colon capsule endoscopy in detecting colon polyps, Gastrointest Endosc., Rokkas et al, 2010
NIH PubMed, Colon capsule endoscopy vs. colonoscopy in patients at average or increased risk of colorectal cancer, Ailment Pharmacol Ther., Sacher-Huvelin et al, 2010
NIH PubMed, Second-generation colon capsule endoscopy compared with colonoscopy, Gastrointest Endosc., Spada et al, 2011

Risk of Death for Colon Capsule Endoscopy

Patient Summary: The capsule can fail to be excreted and instead remain in the digestive tract in approximately 1%-2% of patients undergoing small bowel capsule endoscopy, requiring surgery or endoscopy. EvidenceMD could not find data on large bowel capsule retention.

Professional Summary: The capsule can fail to be excreted and instead remain in the digestive tract in approximately 1%-2% of patients undergoing small bowel capsule endoscopy, requiring surgery or endoscopy. EvidenceMD could not find data on large bowel capsule retention. Cases of acute obstruction and perforation have been reported.

Sourced from:

NIH PubMed, Capsule retention: prevention, diagnosis and management, Ann Transl Med, Rondonotti et al, 2017
NIH PubMed, Capsule retention related to small bowel capsule endoscopy: a large European single-center 10-year clinical experience, United European Gastroenterol J, Nemeth et al, 2017

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