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Who should be screened for colon cancer?

Screening for colon cancer means checking for colon cancer as part of a routine medical check-up in individuals that do not present any signs or symptoms. The risk of getting cancer increases with age. In Canada, the majority of colon cancer cases are diagnosed in people over 50 years old. Responses to treatment are best when colon cancer is detected early, before it spread to other organs. Besides early detection of cancer, screening tests can identify non-cancerous polyps. Removing of these polyps will prevent colon cancer.

The Canadian Cancer Society, the Canadian Association of Gastroenterology, the Royal College of Physicians and Surgeons of Canada and the Canadian Association of Radiologists all advocate periodic screening for cancer of the colon.

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Colon Cancer Screening Tests

  • Fecal occult blood test (FOBT)

    annually or every 2 years – is a simple test that detects hidden or microscopic blood in the stool. If this test is positive, your doctor may recommend other tests to find out the source of the blood. A positive test does not necessarily mean colon cancer, other conditions such as polyps or haemorrhoids can cause bleeding.

  • Double Contrast Barium Enema

    every 5 years – this is a basic x-ray test of the large intestine which is done after the patient has received an enema with a barium solution. This technique may show gross polyps or tumors.

  • Sigmodoscopy

    every 5 years – the doctor uses a short, flexible tube with a fiber optic camera to examine the lining of the rectum and only a small part of the colon, to take biopsies and remove polyps.

  • Traditional colonoscopy

    every 5 years – the doctor uses a long tube with a fiber optic camera to examine the rectum and the entire colon, to take biopsies and remove polyps. This procedure requires a thorough cleansing of the colon prior to the test and sedation or anaesthesia for patient’s comfort.

  • Virtual colonoscopy (CT colonography)

    every 5 years – this latest technology allows a minimally invasive visualization of entire colon with accuracy similar to colonoscopy. It uses computerized tomographic equipment (CT scan) with ultra fast resolution to produce pictures of the colon and rectum.


Unfortunately, less than 20% of Canadians are currently routinely screened for colon cancer.

Because of anxiety, fear, embarrassment or misinformation, many people who should undergo screening for colon cancer are reluctant to do so. However, it is important to understand that the difference between being screened and not, can be the difference between life and death.

There are several tests that can be used to screen for colon cancer. Each one of them has its own benefits and risks. As a patient, it is important to understand that each screening test can detect polyps and colon cancer at various degrees. You should discuss with your doctor as to what the follow-up procedure is if you get a positive test result. Get informed and get involved in the decision.

Men and women aged 50 years with no history

The current medical literature recommends that routine colon cancer screening for average risk individuals (both men and women) should begin at age 50. An average risk individual is a 50 years old patient with no personal history of polyps, colon cancer or inflammatory bowel disease and no family history of polyps or colon cancer. Fecal occult blood test (FOBT) is recommended at least every 2 years and colonoscopy is recommended at a minimum of once every 5 years.

Men and women aged 40 years with personal or family history

It is also recommended that patients with a family history of colon cancer (a first degree relative affected by the disease) or with a personal history of polyps, colon cancer or inflammatory bowel disease start screening about 10 years earlier than the average risk population (at 40 years old) and be tested more frequently.