# Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood)

Source: https://onco.cc/technologies/colorectal-screening/  
OnCo record `colorectal-screening` (Technology). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Finding and removing polyps before they become cancer. Colonoscopy prevents cancer; stool and blood tests catch it early and get more people screened.

## Summary

Colonoscopy every 10 years (finds and removes adenomas), annual FIT, multitarget stool DNA (Cologuard, every 3 years), CT colonography, and since 2024 the Shield blood test (83% sensitivity for cancer, low for advanced adenomas). USPSTF lowered the start age to 45 in 2021 as early-onset CRC rises. Screening is credited with much of the fall in CRC mortality in over-65s; uptake in 45-49-year-olds is low.

## Fields

- Kind: Technology
- Status: standard-of-care
- Last checked: 2026-09-07
- Principle: Detect adenomas or early cancers by direct visualisation (endoscopy), occult blood or shed DNA in stool, or cfDNA methylation and fragmentation in blood.
- Since: 1990
- Strengths: Colonoscopy both detects and prevents by polypectomy; Non-invasive options raise participation
- Limitations: Blood and stool tests miss most precancerous polyps; Colonoscopy capacity and access; Early-onset cancers arise before screening age

## Notes

- The three randomised results screening rests on: annual faecal occult blood testing cut 13-year colorectal cancer mortality by 33 percent in 46,551 people in Minnesota (Mandel 1993); one flexible sigmoidoscopy offered at 55 to 64 cut incidence by 26 percent and mortality by 30 percent over 17 years, and by 35 and 41 percent in those who attended (Atkin 2017); and NordICC cut the 10-year risk of colorectal cancer from 1.20 to 0.98 percent on an invitation basis with 42 percent attendance (Bretthauer 2022).
- Where the programmes start: England invites everyone aged 50 to 74 every two years with a faecal immunochemical test read at 120 micrograms of haemoglobin per gram of faeces (GOV.UK); the US Preventive Services Task Force recommends screening from 50 to 75 (grade A) and from 45 to 49 (grade B), with selective screening to 85 (JAMA 2021).

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Colorectal_cancer_screening
- Wikipedia: https://en.wikipedia.org/wiki/Colorectal_cancer_screening
- Mandel, N Engl J Med 1993: reducing mortality from colorectal cancer by screening for faecal occult blood (Minnesota, 46,551 people): https://doi.org/10.1056/nejm199305133281901
- Atkin, Lancet 2017: UK Flexible Sigmoidoscopy Screening Trial, 17 years of follow-up (170,034 people): https://doi.org/10.1016/s0140-6736(17)30396-3
- Bretthauer, N Engl J Med 2022: NordICC, effect of colonoscopy screening on risks of colorectal cancer and related death (84,585 people): https://doi.org/10.1056/nejmoa2208375
- US Preventive Services Task Force, JAMA 2021: screening for colorectal cancer (start at 45, grade B; 50 to 75, grade A): https://doi.org/10.1001/jama.2021.6238
- GOV.UK: NHS bowel cancer screening programme overview (target population and the screening test): https://www.gov.uk/guidance/bowel-cancer-screening-programme-overview

## Connected records

- roadmaps: [Cancer prevention roadmap: tobacco control and vaccines → biomarker-guided chemoprevention → interception in carriers](https://onco.cc/roadmaps/prevention-roadmap/), [Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation](https://onco.cc/roadmaps/colorectal-roadmap/), [Paths to cures: interception, eradication, control](https://onco.cc/roadmaps/cure-paths/)
- technologies: [AI polyp detection in colonoscopy](https://onco.cc/technologies/ai-endoscopy-detection/), [Breath and volatile-organic-compound detection](https://onco.cc/technologies/breath-vocs/), [Capsule endoscopy (PillCam, EndoCapsule, CapsoCam)](https://onco.cc/technologies/capsule-endoscopy-systems/), [CEA surveillance after colorectal cancer surgery](https://onco.cc/technologies/cea-surveillance-colorectal/), [Global oncology and access in low- and middle-income countries](https://onco.cc/technologies/global-oncology-access/), [Liquid biopsy (ctDNA)](https://onco.cc/technologies/liquid-biopsy/), [Multi-cancer early detection (MCED)](https://onco.cc/technologies/mced/), [Multitarget stool RNA test (ColoSense)](https://onco.cc/technologies/multitarget-stool-rna-test/), [Red and processed meat reduction](https://onco.cc/technologies/red-processed-meat-reduction/)
- cancers: [Colorectal cancer](https://onco.cc/cancers/colorectal/), [Early-onset colorectal cancer (under 50)](https://onco.cc/cancers/early-onset-colorectal/), [Mismatch-repair deficient (MSI-high) colorectal cancer](https://onco.cc/cancers/msi-high-colorectal/)
- fronts: [Early Detection & Screening](https://onco.cc/fronts/early-detection/)
- drugs: [Cologuard](https://onco.cc/drugs/cologuard/), [Cologuard Plus](https://onco.cc/drugs/cologuard-plus/), [Shield](https://onco.cc/drugs/shield/), [SimpleScreen CRC](https://onco.cc/drugs/simplescreen-crc/)
- companies: [Abbott Laboratories](https://onco.cc/companies/abbott/), [Geneoscopy](https://onco.cc/companies/geneoscopy/), [Norgine](https://onco.cc/companies/norgine/), [Zeria Pharmaceutical](https://onco.cc/companies/zeria/)
- terms: [Adenoma detection rate](https://onco.cc/terms/adenoma-detection-rate/), [Adenoma-carcinoma sequence](https://onco.cc/terms/adenoma-carcinoma-sequence/), [Faecal immunochemical test (FIT)](https://onco.cc/terms/fit-test/), [Faecal occult blood test (guaiac)](https://onco.cc/terms/faecal-occult-blood-test/), [Interval cancer](https://onco.cc/terms/interval-cancer/), [Lynch syndrome](https://onco.cc/terms/lynch-syndrome/), [NHS bowel cancer screening programme](https://onco.cc/terms/bowel-cancer-screening-uk/), [Polyp types in the bowel](https://onco.cc/terms/colorectal-polyp-types/), [Screening uptake](https://onco.cc/terms/screening-uptake/), [Serrated pathway](https://onco.cc/terms/serrated-pathway/), [Surveillance intervals after polypectomy](https://onco.cc/terms/colonoscopy-surveillance-intervals/)
- trials: [BLUE-C](https://onco.cc/trials/blue-c/), [DeeP-C](https://onco.cc/trials/deep-c/), [ECLIPSE (Shield blood test)](https://onco.cc/trials/eclipse-shield/), [Funen faecal occult blood screening trial](https://onco.cc/trials/funen-fob/), [Minnesota Colon Cancer Control Study](https://onco.cc/trials/minnesota-fob/), [National Polyp Study](https://onco.cc/trials/national-polyp-study/), [NordICC (Nordic-European Initiative on Colorectal Cancer)](https://onco.cc/trials/nordicc/), [Nottingham faecal occult blood screening trial](https://onco.cc/trials/nottingham-fob/), [PREEMPT CRC](https://onco.cc/trials/preempt-crc/), [UK Flexible Sigmoidoscopy Screening Trial](https://onco.cc/trials/ukfss/)
- institutions: [Bowel Cancer UK](https://onco.cc/institutions/bowel-cancer-uk/), [Case Comprehensive Cancer Center](https://onco.cc/institutions/case-ccc/), [Kaiser Permanente Division of Research](https://onco.cc/institutions/kaiser-permanente-research/), [Markey Cancer Center, University of Kentucky](https://onco.cc/institutions/kentucky-markey/)
- key papers: [Clinical validation of a circulating tumor DNA-based blood test to screen for colorectal cancer (PREEMPT CRC)](https://onco.cc/key-papers/paper-preempt-crc-shaukat-jama-2025/), [Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths (National Polyp Study)](https://onco.cc/key-papers/paper-zauber-national-polyp-study-colonoscopic-polypectomy-nejm-2012/), [Colorectal cancer incidence patterns in the United States, 1974-2013](https://onco.cc/key-papers/paper-siegel-colorectal-incidence-birth-cohort-jnci-2017/), [Colorectal cancer statistics, 2023](https://onco.cc/key-papers/paper-siegel-colorectal-cancer-statistics-ca-2023/), [Genetic alterations during colorectal-tumor development](https://onco.cc/key-papers/paper-vogelstein-genetic-alterations-colorectal-tumor-development-nejm-1988/), [Increasing incidence of colorectal cancer in young adults in Europe over the last 25 years](https://onco.cc/key-papers/paper-vuik-early-onset-colorectal-europe-gut-2019/), [Long term effects of once-only flexible sigmoidoscopy screening after 17 years of follow-up](https://onco.cc/key-papers/paper-atkin-flexible-sigmoidoscopy-17-year-follow-up-lancet-2017/), [Minnesota trial: a yearly stool blood test cuts bowel cancer deaths by a third](https://onco.cc/key-papers/paper-minnesota-fobt-nejm-1993/), [Multitarget stool DNA testing for colorectal-cancer screening](https://onco.cc/key-papers/paper-imperiale-multitarget-stool-dna-screening-nejm-2014/), [NordICC: inviting people to a screening colonoscopy reduced bowel cancer, but less than expected](https://onco.cc/key-papers/paper-nordicc-nejm-2022/), [Once-only flexible sigmoidoscopy screening in prevention of colorectal cancer: a multicentre randomised controlled trial](https://onco.cc/key-papers/paper-atkin-once-only-flexible-sigmoidoscopy-lancet-2010/), [Quality indicators for colonoscopy and the risk of interval cancer](https://onco.cc/key-papers/paper-kaminski-adenoma-detection-rate-interval-cancer-nejm-2010/), [Randomised controlled trial of faecal-occult-blood screening for colorectal cancer (Nottingham)](https://onco.cc/key-papers/paper-hardcastle-nottingham-faecal-occult-blood-lancet-1996/), [Randomised study of screening for colorectal cancer with faecal-occult-blood test (Funen)](https://onco.cc/key-papers/paper-kronborg-funen-faecal-occult-blood-lancet-1996/)
- ideas: [Find out what is driving early-onset bowel cancer, starting with colibactin, before extending screening any further](https://onco.cc/ideas/idea-crc-early-onset-cause-hunt/), [Treat screening uptake, not test sensitivity, as the thing to optimise, and settle the age extension with a trial rather than a model](https://onco.cc/ideas/idea-crc-screening-uptake-and-age-extension/), [UK gap: match endoscopy capacity and quality to the faecal immunochemical test thresholds the NHS has already set](https://onco.cc/ideas/idea-crc-uk-colonoscopy-capacity-and-fit-threshold/), [UK gap: shorten the route to diagnosis for patients below the screening age, where the rise in incidence is](https://onco.cc/ideas/idea-crc-uk-young-patient-referral-and-diagnostic-interval/)
- people: [Chadwick Boseman](https://onco.cc/people/chadwick-boseman/), [Dame Deborah James](https://onco.cc/people/deborah-james/), [Hermann Brenner](https://onco.cc/people/hermann-brenner/), [Katie Couric](https://onco.cc/people/katie-couric/)
- bottlenecks: [Inherited risk is mostly unidentified](https://onco.cc/bottlenecks/b-hereditary-risk/), [The hardest cancers are found late](https://onco.cc/bottlenecks/b-early-detection/)
- collections: [American Cancer Society (ACS)](https://onco.cc/collections/american-cancer-society/), [Australia's national cancer screening programs](https://onco.cc/collections/australia-cancer-screening-programs/), [Colorectal Cancer Alliance](https://onco.cc/collections/colorectal-cancer-alliance/), [Ireland's National Screening Service](https://onco.cc/collections/ireland-national-screening-service/), [NHS cancer screening programmes](https://onco.cc/collections/nhs-cancer-screening-programmes/), [Time to Screen (New Zealand national screening)](https://onco.cc/collections/nz-time-to-screen/)
- pathways: [Mismatch repair & microsatellite instability](https://onco.cc/pathways/mismatch-repair-msi/)

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