The screening that can prevent cancer, not just find it.
Colon cancer screening starts at 45 now, and you have more choices than a colonoscopy, including a test you do at home. If you got a reminder from us, our records show you're due. Here's how to pick the test that fits you.
Why colorectal screening matters
Colorectal cancer is the second leading cause of cancer death in the U.S. for men and women combined, and the American Cancer Society now reports it as the leading cause of cancer death in adults under 50. Screening is unusually powerful here: most colorectal cancers start as slow-growing polyps, and finding and removing a polyp prevents the cancer from ever forming. When cancer is found, screening usually finds it at an early, highly treatable stage.
Who should be screened, and when
These ages are for people at average risk, with no symptoms and no strong family history.
Ages 45 to 75
Regular screening for everyone, recommended by the U.S. Preventive Services Task Force (2021) and the American Cancer Society. The starting age dropped from 50 to 45 because colorectal cancer has been rising steadily in younger adults.
Ages 76 to 85
An individual decision. We consider your overall health, life expectancy, and whether you've been screened before. Someone who has never been screened often still benefits.
Over 85
Screening is generally no longer recommended, because the risks of testing and treatment start to outweigh the benefit. Symptoms at any age still deserve a visit.
Three ways to get screened through PremierMD
Most people at average risk choose one of these three paths. We'll help you pick the one you'll actually follow through on.
Colonoscopy
The most thorough option, and the only one that removes polyps in the same visit. We refer you to one of our affiliated gastroenterology practices and stay in touch on your results.
Cologuard at Home
No prep and no time off. Once we order it, Exact Sciences, the company that makes Cologuard, ships the kit directly to your home, and you mail your sample back to them. The results come to us.
Shield™ Blood Test
For patients who would rather not do a stool test or a colonoscopy: a single blood draw, repeated every 3 years. It finds fewer precancerous polyps, so it works best as the alternative to skipping screening.
Every test option, compared
Every test below is a recognized way to screen people at average risk. They differ in how often you repeat them and how much preparation they take. The best test is the one that gets done.
Cologuard (Stool DNA-FIT)
Every 3 years, at home. You collect one stool sample with a kit mailed to you and ship it back. No prep, no diet changes, no time off. Available through PremierMD, and our preferred at-home option for average-risk patients.
FIT (Fecal Immunochemical Test)
Every year, at home. A simple kit that checks a small stool sample for hidden blood. Inexpensive and well studied, but it only works if you repeat it every single year.
Colonoscopy
Every 10 years if normal. A gastroenterologist examines the whole colon with a camera and removes polyps during the same procedure. Needs a bowel prep the day before and sedation, so plan on a driver and most of a day.
CT Colonography
Every 5 years. A CT scan that builds a 3D picture of the colon. It needs the same bowel prep but no sedation. If it shows a polyp, you'll need a colonoscopy to remove it.
Flexible Sigmoidoscopy
Every 5 years, or every 10 years plus a yearly FIT. A shorter scope exam of the lower part of the colon, with a lighter prep and usually no sedation. Less commonly used today.
Shield™ Blood Test
Every 3 years, one blood draw. FDA-approved for adults 45 and older at average risk, and offered here. It finds fewer precancerous polyps than the tests above, so guidelines treat it as a backup for people who won't do a stool test or colonoscopy.
A positive stool or blood test isn't a diagnosis. Most positives turn out to be polyps or nothing, but every positive result needs a follow-up colonoscopy to complete the screening. Most private plans and Medicare now count that colonoscopy as part of screening, so it's usually covered without cost-sharing. Confirm with your plan.
If you're at higher risk
Stool and blood tests are built for average-risk screening. If any of these apply to you, screening usually starts earlier and uses colonoscopy on a set schedule:
- A parent, sibling or child with colorectal cancer or an advanced polyp: start at 40, or 10 years before the age your relative was diagnosed, whichever comes first
- Inflammatory bowel disease (Crohn's disease or ulcerative colitis), usually starting about 8 years after symptoms began
- An inherited syndrome such as Lynch syndrome or familial adenomatous polyposis (FAP), which can mean colonoscopy from your 20s or even your teens
- A personal history of polyps or colorectal cancer, which moves you onto a surveillance schedule set by what was found
Not sure where you fall? Family history is easy to get wrong, so bring what you know to your visit and we'll sort out the right start age and interval.
Due for colon screening? It can start with a video visit.
Call (908) 450-7002 or book online. We can talk through your options and order Cologuard by telemedicine, shipped directly to your door by Exact Sciences.
Symptoms aren't screening
Screening is for people who feel fine. If you have any of these, don't wait for a stool test: call us for a diagnostic visit, at any age.
Rectal Bleeding
Blood in or on the stool, or stools that look dark or black. Often hemorrhoids, but it always deserves a proper look.
Bowel Changes
New constipation, diarrhea, narrower stools, or a feeling of not emptying fully that lasts more than a few weeks.
Unexplained Weight Loss
Losing weight without trying, especially with fatigue or a change in appetite.
Iron-Deficiency Anemia
Low iron on a blood test without an obvious cause, particularly in men or women past menopause.
Colonoscopy prep and the day itself
For a few days before, you'll usually eat low-fiber foods. The day before, you switch to clear liquids and drink a prescribed laxative prep, most often split into an evening dose and a second dose a few hours before your appointment. It's the least pleasant part, and following it exactly is what lets the doctor see clearly. Let us and the gastroenterologist know about blood thinners, diabetes medications and GLP-1 medications such as semaglutide or tirzepatide, which may need adjusting beforehand.
On the day, the procedure itself takes about 30 to 60 minutes under sedation, and most people remember little of it. Any polyps are removed on the spot and sent to the lab. Because of the sedation you'll need someone to drive you home, and most people are back to their normal routine the next day.
How PremierMD helps
We help you choose a test and then make it happen: a colonoscopy referral to one of our affiliated gastroenterology practices, Cologuard shipped directly to your home by Exact Sciences, or the Shield™ blood test if neither of those suits you. We can also order a FIT kit. We track your results and your next due date in your chart, so a positive stool test gets its follow-up colonoscopy and our primary care team can remind you when you're due again.
The screening conversation and a Cologuard order can happen in a telemedicine visit. Men can also fold it into a preventive screening visit, and anyone can raise it at their annual physical.
Covered by most plans
Under the Affordable Care Act, most health plans cover colorectal cancer screening from 45 at no cost to you. Medicare covers stool tests, the Shield blood test, CT colonography and colonoscopy at set intervals, and counts the colonoscopy after a positive stool or blood test as part of screening.
One thing to check first: if a polyp is removed during a screening colonoscopy, some plans bill part of the visit differently, and Medicare currently charges a 15% coinsurance for that, falling to zero by 2030. Ask your insurer before your procedure. Our insurance and billing page lists the plans we accept.
Related preventive care
Preventive Care & Annual Physicals
Your yearly visit is where we review every screening you're due for, from blood pressure to cancer screening.
Learn moreMen's Preventive Screening
Age-based cardiovascular, diabetes and cancer screening, decade by decade.
Learn moreMammogram Screening
Who needs a mammogram and how often, dense breasts, and what to expect on the day.
Learn moreOn-Site Lab Work
Walk-in blood draws at our Bridgewater office, plus Cologuard and Shield colon cancer screening.
Learn moreFamily Medicine
One practice for your whole family's care, so screening results feed into a plan with providers who know your history.
Learn moreFrom Our Blog: What to Expect at Your Annual Physical
A full walkthrough of the yearly visit, including which screenings come up at which age.
Read the guideColorectal screening questions
When should I start colon cancer screening?
At 45 if you're at average risk, continuing through 75. That's the recommendation of both the U.S. Preventive Services Task Force (2021) and the American Cancer Society. Between 76 and 85 the decision is individual, based on your health and past screening. If a close relative had colorectal cancer or advanced polyps, or you have inflammatory bowel disease or an inherited syndrome, screening usually starts earlier and uses colonoscopy.
Is Cologuard as good as a colonoscopy?
They do different jobs. Colonoscopy is the most thorough test and lets the doctor remove polyps on the spot, but it needs a bowel prep and sedation. Cologuard is done at home, finds most colorectal cancers, and is a strong choice for people at average risk, especially anyone who would otherwise put screening off. It's repeated every 3 years, and a positive result means a follow-up colonoscopy. The best test is the one that actually gets done.
What happens if my Cologuard or FIT test is positive?
A positive stool test doesn't mean you have cancer. Most positive results turn out to be polyps or nothing at all. It does mean you need a colonoscopy to finish the screening, ideally within a few months, and we'll refer you and follow up until it's done. Most private plans and Medicare now treat that follow-up colonoscopy as part of screening, so it's usually covered without cost-sharing; check with your plan to confirm.
Can I use a blood test instead?
We offer Guardant Shield, an FDA-approved blood test for adults 45 and older at average risk, repeated every 3 years. It's convenient, but it finds fewer precancerous polyps than stool tests or colonoscopy, so it can't prevent as many cancers. The American Cancer Society's May 2026 guideline lists blood tests as an option for people who won't do a stool test or a colonoscopy, and the Task Force's current recommendation doesn't include them yet. A positive result needs a follow-up colonoscopy.
Who should get a colonoscopy instead of a stool test?
People at higher than average risk: a parent, sibling or child with colorectal cancer or advanced polyps, a personal history of polyps or colorectal cancer, Crohn's disease or ulcerative colitis, or an inherited syndrome such as Lynch syndrome or FAP. Stool and blood tests are designed for average-risk screening, so these situations usually call for colonoscopy on a set schedule.
What is colonoscopy prep like?
The day before, you switch to clear liquids and drink a prescribed laxative, usually split into an evening dose and a second dose a few hours before the procedure. It's the least pleasant part, and following the instructions exactly is what makes the exam accurate. The procedure takes about 30 to 60 minutes under sedation, you'll need someone to drive you home, and most people are back to normal the next day.
Is colorectal cancer screening covered by insurance?
Usually. Under the Affordable Care Act, most plans cover screening from 45 at no cost to you, and Medicare covers stool tests, blood tests, CT colonography and colonoscopy at set intervals. One catch: if a polyp is removed during a screening colonoscopy, some plans bill part of it differently, and Medicare currently charges a 15% coinsurance for that, falling to zero by 2030. Check with your insurer before your colonoscopy.
Do I need to come into the office to get screened?
No. The screening conversation and a Cologuard order can happen in a telemedicine visit, and Exact Sciences, the company that makes Cologuard, ships the kit directly to your home. A colonoscopy is done at one of our affiliated gastroenterology practices, and we handle the referral.
Contact PremierMD Today
We'll reach out within one business day to answer your questions and help you schedule an appointment.