Colonoscopy vs. At-Home Test: Which is Better?

March 12th, 2024

Colonoscopy vs. At-Home Test: Which is Better?

If you’re age 45 or older, you need to get screened for colorectal cancer. But many people wonder which type of screening is better, a colonoscopy or an at-home test such as Cologuard.

“The most important thing is to get screened, no matter how you do it,” says Daniel Latta, MD, a double-board certified, fellowship-trained colorectal surgeon with Grand View Health Surgery. Here’s his take on the pros and cons of colonoscopy vs. an at-home test.

Colonoscopy: Pros and cons

“A colonoscopy remains the gold standard for finding tumors and polyps in their earliest and most treatable stages,” Dr. Latta says. What makes colonoscopy unique is that it’s the only therapy offering both diagnosis and treatment for colorectal cancer.

Colonoscopies are performed under mild-to-moderate anesthesia. You will need to do some kind of bowel preparation prior to the procedure, which may include taking fluid and/or laxatives to clean your bowels.

During the test, a specially trained doctor (gastroenterologist) will examine your colon using a flexible tube with a camera at the end. “Nearly all polyps and some early-stage colon cancers can be removed during a colonoscopy,” Dr. Latta says.

People at average risk should get a colonoscopy once every 10 years. If a colonoscopy reveals a positive finding (a tumor or polyp), then you should repeat your colonoscopy sooner. Your doctor will advise on the time frame that’s right for you.

At-home tests: Pros and cons

At-home tests like Cologuard look for traces of blood or abnormal DNA within your stool that may indicate signs of colorectal cancer. These tests require no prep and can be done within the comfort of home. It’s up to you to collect a stool sample, insert it into a container filled with a preservative, and then mail it back to the lab.

While at-home tests offer convenience, “if you have a positive result, you will still need to have a colonoscopy,” Dr. Latta says. You also need to perform at-home tests more frequently than colonoscopy. Experts recommend repeating at-home tests once every three years if you have a negative result.

Are there other colorectal cancer screenings available?

Additional colorectal cancer screening options include:

  • FIT (fecal immunochemical test): This screening checks for signs of blood in your stool, which can be a sign of colorectal cancer.
  • Flexible sigmoidoscopy: This test is less invasive than a colonoscopy, but it only examines the lower portion of the colon.
  • Virtual colonoscopy (CT colonography): This screening is performed with a low-dose CT scan of your colon.

With all of these screenings, you will still need a colonoscopy if any positive findings are indicated. Talk with your doctor about which of these options might be best for you.

Who needs colorectal cancer screening?

Colorectal cancer is now the deadliest cancer for men under age 50 and the second deadliest for women under age 50. That’s why the most recent U.S. Preventive Services Task Force guidelines recommend that EVERYONE get screened as soon as they turn 45.

“Unfortunately, younger patients are often reluctant to get screened, and they typically don’t see their doctors as often as older people,” Dr. Latta says. “But when they delay screening, they may also delay their diagnosis and treatment, so we might not find their cancer until it’s in a later, less treatable stage.”

You should get your first colorectal screening earlier than age 45 if you have:

  • Inflammatory bowel disease (Crohn’s or ulcerative colitis)
  • A first-degree family member with colorectal cancer
  • Certain genetic conditions (Familial Adenomatous Polyposis or Lynch Syndrome)

“If you have any of these increased risk factors, ask your doctor for the best screening strategy,” Dr. Latta says. People between ages 75 – 85 should also discuss the frequency of screening with their doctor.

What happens if I get a positive screening test?

If a screening finds colorectal cancer, you can get expert care close to home. As a member of the Penn Cancer Network, Grand View Health offers advanced treatments for colorectal cancer, including robotic-assisted surgery and bowel-sparing procedures.

“People in Bucks and Montgomery counties benefit from an excellent multidisciplinary team that delivers exceptional care, close to home,” Dr. Latta says. “Many of our patients can even continue working during treatment because they have nearby access to their doctors and care team.”

Colorectal cancer remains highly treatable if found in its earliest stages. Get screened today and reduce your risk.

Learn more about cancer care at Grand View Health.