Nobody has ever walked into my office and said, "Doc, I'm so excited to talk about my colon." I get it. It's awkward, it's a little gross, and it's easy to put off until next year. Then next year turns into five.

So let's make this quick and painless, because this is one of the best bits of prevention we have.

Why you can feel perfectly fine and still need it

Polyps are small growths in the colon or rectum. Some of them can turn into cancer if nobody removes them. The catch is that polyps and early colorectal cancer often don't cause any symptoms. CDC says you could have them and not know it. That's the whole point of screening: looking when you feel fine, so we can find a problem early, or remove a polyp before it becomes one.

CDC reports colorectal cancer is the fourth most common cancer among men and women in the US. And it's one of the few where a test can catch things before they turn into cancer.

Who and when

The US Preventive Services Task Force recommends screening for adults 45 to 75. That age used to start at 50, and it moved down to 45 in 2021. Between 76 and 85, it's an individual call, so talk with your clinician. If you've got inflammatory bowel disease, a family history of polyps or colorectal cancer, or a genetic syndrome, you may need to start earlier or get tested more often. Ask.

And here's the number that bugs me: in CDC's 2022 data, only about 61 percent of adults 45 to 75 were up to date. The national goal is about 73 percent. Lots of people are just one phone call from being done.

"Do I have to do the colonoscopy?"

Not necessarily. You've got options, and the best test is the one you'll actually do. CDC lists these:

  • A stool test called FIT, done at home once a year. You collect a small sample and send it in.
  • A stool DNA test (FIT-DNA), done at home once every 3 years. You collect a whole bowel movement and mail it to a lab.
  • A colonoscopy, once every 10 years if you're at average risk. A doctor checks the whole colon, and can remove most polyps during the same visit.
  • A couple of other options, like CT colonography or flexible sigmoidoscopy, which your clinician can walk you through.

One thing to know: if a stool test comes back abnormal, you'll need a colonoscopy to finish the job. That's not a failure. That's the system working.

A short checklist

  • Look at your birthday. If you're 45 or older, ask whether you're up to date.
  • Ask your family if anybody had polyps or colorectal cancer, and at what age. Write it down.
  • Pick the test that fits your life and your risk, together with your clinician.
  • If you're due for a colonoscopy, ask what the prep involves and book it for a day you can take it easy.
  • If you did a test years ago and can't remember when, ask your doctor's office to check your chart.

When it's not a screening question

Screening is for people without symptoms. If you do have symptoms, don't wait for a routine screening to bring them up. CDC lists a change in bowel habits, blood in or on your stool, diarrhea, constipation, or a feeling that your bowel doesn't empty all the way, belly pain or cramps that don't go away, and weight loss you can't explain. Those can have plenty of causes, but they deserve a real evaluation, not a wait-and-see. If you're passing a lot of blood, feel faint, or have severe belly pain, get emergency care.

For everything else, here's the move: this week, find out when you're due, and make the call. Catching something early, or removing a polyp before it turns into a problem, beats a lot of expensive trouble later.

This is general education, not a diagnosis or a treatment plan for you. Symptoms, history, exam findings, and other conditions change what care is right. Talk with your own clinician for advice tailored to you.