Colorectal cancer screening goes beyond detecting cancer. It prevents cancer.

If polyps, or growths, are detected and removed during a colonoscopy, then cancer might have been prevented because some polyps turn cancerous.

At Kaiser Permanente, screening begins with a stool test called FIT, short for fecal immunochemical test. The FIT test, which is done at home, looks for blood in the stool. That hidden blood could be a sign of colon cancer or colon polyps. If FIT results are positive, the next step is a colonoscopy to check the inner lining of the colon and rectum for cancer.

Theodore R. Levin, MD, clinical lead for colorectal cancer screening, shares why screening at 45 is a must, the importance of a colonoscopy when a FIT test is positive, and common misunderstandings about colorectal cancer.

Tell us why screening now begins at 45.

Screening used to begin at 50, but a few years ago the guidelines changed for people at average risk because adults are getting colorectal cancer at younger ages. In 2023, the American Cancer Society reported that 20% of colon cancer cases were among people 55 and younger.

The biggest issue with younger people is a delay in seeking care because they are not familiar with the risks, figuring it couldn’t be cancer because of their age.

It also doesn’t help that that early symptoms for colon cancer, such as rectal bleeding, anemia and change in bowel habits can be confused with really common conditions. People don’t always take them seriously. Even when I find a cancer in somebody young and ask, ‘Were you having bleeding?’ They’ll often say, ‘Oh yeah, I was. But I didn’t think to tell my doctor about it.’

It’s best to stay updated on your screening, and the FIT test is quick and noninvasive. We are a leader in screening this age group, gradually increasing each year. In 2024, 59 percent of our members 45 to 50 years old were screened. But, as with other health screenings, the younger people screen at a lower rate than older people. We can do better, and we need to raise awareness that 45 is the new 50.

How hard is it to get people with a positive FIT test to get a colonoscopy?

It’s very important that people who get a positive FIT test follow up with a colonoscopy to see what’s really going on.

Over 80% of our members get a colonoscopy after a positive FIT test. Some people resist a colonoscopy because it requires taking off work, finding a driver, being sedated, doing the uncomfortable preparation, and following a strict diet for about a week before the procedure. People can be fearful of the procedure out of concern for a cancer diagnosis. It’s important to know that cancer is rare even if the FIT is positive, but we do find polyps more than half the time. By removing polyps, we can prevent cancer over the next 5-10 years.

People also might misunderstand the cost. There’s no co-pay with a colonoscopy after a positive FIT because it’s a preventive screening.

What else are people misunderstanding about colon cancer?

People often think you need to have symptoms to have cancer. That’s not true.

Or they think you don’t have a risk if you don’t have a family history. While your risk is higher if you have a family history, you can still get colorectal cancer.

People may think colonoscopy is the only way to get screened, but that’s not true either.

What people need to know is that screening really works. If you catch it early, before it spreads, colon cancer has one of the best chances of survival of any cancer.