Colonoscopy vs. At-Home Tests: Which Colon Cancer Screening Is Right for You?
What to know about new at-home screening tests for colon cancer
Key Takeaways
Colonoscopies are the gold standard for screening: These are the only type of test that can actually remove precancerous or cancerous polyps.
Preparation is key: Most people who have had one know that the prep is almost always the hardest part, and even that is getting easier
New options are emerging: But other FDA-approved options have emerged that may be a convenient alternative for those at lower risk for colon cancer. There are stool and blood-based tests available today, with varying degrees of effectiveness in detecting colon cancer.
How to decide: Determining if one of these tests is right for you has to do with risk factors like age and family history, overall health, comfort with sedation, and more.
If you’re worried about your colon health or just want to be proactive, book a visit today!
by Caylin Cheney, Advanced Registered Nurse Practioner
Let’s be real: I’ve yet to meet a patient who is excited about a colonoscopy. I get it—between the scary stories about the prep and the general anxiety of the procedure, it’s easy to want to push it to the bottom of your to-do list.
But as a nurse practitioner, my goal isn’t to just hand you a clinical checklist; it’s to help you feel safe and empowered. And luckily, the truth is that screening options have changed a lot recently. From much easier prep options to high-tech tests you can do from the comfort of your home, you have more choices to help prevent colon cancer than ever before.
Let’s look at what’s actually involved and find a path that fits your life—because, in my opinion, the best test is always the one that actually gets done.
If you’re looking for more information on the basics of colon cancer – like what it is, the signs and symptoms, and why it’s on the rise in young people – check out the first blog in this series here.
Before we jump into at-home options: Did you know colonoscopy prep is getting easier?
You’re probably already familiar with colonoscopies – a visual exam of your large intestine performed by a gastroenterologist using a camera attached to a flexible tube. It usually takes less than an hour and if your provider finds polyps (small clumps of cells that form on the lining of the colon that can slowly turn into cancer), they are removed right then and there.
A colonoscopy can sound pretty intimidating or anxiety-inducing for a lot of patients. That’s part of why only about two-thirds of people who should be getting one actually do. Colonoscopies are the gold standard for screening: the only type of test that can actually remove precancerous or cancerous polyps.
But most people who have had one know that the prep is almost always the hardest part, and even that is getting easier.
In order for a gastroenterologist to examine your colon, looking for polyps and other signs of disease, it has to be clear. This used to require drinking a gallon of a salty laxative mixture in a short period of time. But today, other more manageable options are available, like SUPREP, CLENPIQ, and Prepopik. These options require drinking less liquid and are split up into two doses – with patients experiencing less discomfort and nausea (and often resulting in a cleaner colon). There are also pill-based options like SUTAB if you prefer a non-liquid approach.
And as you prepare for a colonoscopy, be sure to talk to your provider about an anti-nausea medication like Zofran if you’re concerned about that, too.
Colonoscopies are also done under sedation
Many of my patients don’t realize that colonoscopies are performed under sedation – and you won’t remember it much or at all. There are different options for how much sedation you can choose to have: No sedation, light to deep sedation, or general anesthesia.
You should feel empowered to talk through these options with your provider, especially if you’re a bit nervous! Factors that can influence your decision include your anxiety levels about the procedure, how much recovery time you can or want to take, how much support you have at home, and your overall health factors.
There are new at-home screening options for colon cancer. Here’s how they work
In recent years, other FDA-approved options have emerged that may be a convenient alternative for those at lower risk for colon cancer:
Stool-Based Tests (DNA & RNA)
Stool tests work by analyzing a sample you collect in private and mail to a lab. Beyond just looking for blood, the newest generation of tests looks for molecular "clues.” These tests are better at identifying colorectal cancer and less effective at identifying precancerous polyps. If you get a positive result, you’ll need to follow up with a colonoscopy with your provider.
Cologuard Plus (Next-Gen sDNA): Launched recently as an upgrade to the previous Cologuard test, this new version works in two ways: it identifies abnormal DNA markers and hidden blood in your stool. Blood can be an indicator of polyps or cancer, but it’s not always visible to the eye. The test boasts a 95% sensitivity for detecting colorectal cancer and has significantly reduced the "false positive" rate of its predecessor (though false positives can still happen).
ColoSense (Stool RNA): This is a newer type of test that uses RNA-based technology to detect eight specific biomarkers as well as blood in your stool. Clinical trials have shown it to be over 93% accurate in detecting cancer, making it a good option for early-stage catches.
Blood-Based Screening
Approved in 2024, the Shield blood test is another big advancement in screening options for colorectal cancer. As the name suggests, this test is performed via a simple blood draw at your provider’s office. It works by identifying "cell-free” DNA that cancer leaks into the bloodstream.
This test is super convenient. But Stanford Medicine researchers note that, while blood tests are good at finding existing cancer (about 83% sensitivity), they are less effective at finding the precancerous polyps that a stool test or colonoscopy might catch.
As a provider, I do still think that if it's a choice between not doing a screening and getting a blood test, the blood test would be worth it! To help make that decision, knowing your family history and other risk factors for colon cancer are helpful. It should always be a discussion between you and your provider.
Are at-home screenings for colon cancer right for you?
At-home tests are a great option for average-risk adults (those with no family or personal history of polyps). They offer a low-prep alternative that fits into a busy schedule. However, they are not for everyone, especially those at higher-risk for colorectal cancer.
In my opinion, getting screened for colon cancer in whatever way you are willing to is better than not getting screened at all (as I mentioned above). When talking about options with my patients, I recommend they consider a few things:
Do you have a personal or family history of polyps?
Do you have a history of bowel diseases?
Will it ease your mind knowing if you’ve had the most effective type of screening?
Are you comfortable with or uneasy about sedation?
Did you know colon cancer can be different in women than in men?
In my last blog, we talked a lot about the rise of colon cancer in young people. But emerging research shows that women and men experience different signs, risk factors, and forms of colon cancer, too.
While men tend to have a higher rate of colon cancer, women have a “higher prevalence of right-sided colon cancer, a deadlier form of the cancer that is associated with a 20% increased risk of death compared with cancer of the left side,” according to a recent study.
My main takeaway as a nurse practitioner? If as a woman, you develop new abdominal symptoms, blood in stool, or iron deficiency anemia, it’s important to talk to your provider, ask questions, and make sure your colon cancer risk or screening interval recommendations haven't changed.
Of course, this research is about folks who are assigned female at birth. We continue to need more research about how many diseases and conditions affect transwomen (and more research on trans health and wellness in general).
Do you want to talk more about options for testing and reducing your risk of colon cancer?
Deciding between a stool-based DNA test, a new blood-based screen, or a traditional colonoscopy doesn't have to be something you navigate on your own. I am ready to support you – as a nurse practitioner, I am focused on providing care that feels personal, creates safety, and doesn’t separate your body from your story.
If you’re in Washington state and this approach resonates with you, I’d love to connect. You can book a primary care appointment or schedule a free 20-minute meet-and-greet to get started.
Don’t forget: Colon cancer is one of the most preventable diseases we face, but only if we take the first step toward detection!
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