Colonoscopy vs. at-home colon cancer screening: Which one should I get?
Testing for colon cancer has become easier than ever, thanks to more screening options. Find out more about whether you should get a colonoscopy or take a test at home.
The information in this article is for educational purposes only and is not intended to replace medical advice from your doctor.
Colon cancer screening has changed dramatically in the past decade. A colonoscopy was the only way to test for colon cancer prior to 2014, when the U.S. Food and Drug Administration approved Cologuard as the first noninvasive at-home screening test. It was a welcome improvement for many who skipped cancer screenings because they didn’t want to deal with what they viewed as an invasive and awkward procedure.
Testing for colon cancer is extremely important. According to the American Cancer Society, colorectal cancer is the third most common cancer in the United States. Experts recommend regular screenings starting at age 45 for those without a family history of the disease, and colonoscopies every 10 years if your previous results were negative.
“The prognosis for colon cancer is great if we’re able to catch it early, which is important since we’re seeing more younger people with the disease,” says family nurse practitioner Patricia Wells, FNP-BC with Matrix Medical Network in Detroit.
While it may be tempting to skip the more invasive test for a more comfortable and private option, home testing isn’t right for everyone. Find out more about which type of test is best for you.
What’s the difference between a colonoscopy and an at-home test?
A colonoscopy is a medical procedure where a doctor examines the inside of the colon with a long, flexible tube called a colonoscope. It has a camera and a light on one end, which allows the doctor to look for abnormalities in the lining of the colon, such as swollen tissue, ulcers, polyps, and cancerous cells.
Colonoscopies require you to follow a special diet to clean out your bowels before the procedure. You also are sedated during a colonoscopy, so you’ll need to arrange for a ride home afterward.
At-home tests — which include Cologuard and FIT (fecal immunochemical test) — are prescription tests that you take at home. Your Health and Well-being Assessment may include one of these leave-behind testing kits. There is no bowel prep work necessary. You mail a stool sample directly to the lab in a box or envelope that’s provided with the kit. These tests look for DNA abnormalities or blood in the stool.
While one testing option is obviously more convenient than the other, colonoscopies are still the gold standard for detection. According to a 2022 study in the New England Journal of Medicine, they can reduce the likelihood of getting colorectal cancer by 20 to 30%.
How do I decide which test I should take?
Which test is right for you depends on a few factors: your age, family history, and any related symptoms you may have such as bloating, bloody stools, cramping, change in stools, or unexplained anemia. If you don’t have any risk factors, your health care provider may decide that an at-home test is a good place to start.
But there are limitations to at-home test kits. According to a study in the journal Gastroenterology & Hepatology, at-home tests can give false negatives and positives. They also can miss detecting polyps altogether. Plus, if your at-home test detects an irregularity, you will need to get a colonoscopy to follow up.
Wells explains how she determines which tests to recommend to her patients.
“If I have a 45-year-old with no family history of colon cancer and no symptoms, I suggest doing an at-home test,” she says. “Then if it’s negative, we’d wait until age 50 to do a colonoscopy. If you have a family history of colon cancer or are reporting any symptoms, in that case we’d bypass the at-home tests and go directly to a colonoscopy.”
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How do you take the at-home test correctly?
To up the odds that you do it properly, Wells explains how to take an at-home test:
Use the paper provided. “Your test will come with a paper that you put over the toilet bowl, and that’s where you’re supposed to collect the sample,” she says. “You don’t want to collect the sample from the toilet bowl itself. You want to only get the sample and nothing else.”
Get past the awkwardness. It’s not the most natural thing in the world to take your own stool sample, so just relax and know you’re doing something important for yourself. “The first and most important tip is simply to breathe,” says Wells.
Send your sample to the lab right away. Mailing the box with your stool sample the day you take the test or the day afterward gives you the most accurate results.
What if I don’t want to deal with getting a colonoscopy?
The idea of a colonoscopy can be unnerving if you’ve never had one, and that’s where simple education comes into play.
“I have assisted with colonoscopies, so I’m able to describe the experience to my patients,” says Wells. “I’ve found that once people have a full understanding of the test and why it’s important to do, their fears go away.”
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Don’t put off getting tested
Whichever test you and your doctor choose, it’s important that you have colon cancer screenings. Wells advises that people take an at-home test or get a colonoscopy during their birthday month.
“That way, you’ll remember when you’ve done it, but you’re also taking the time to celebrate your life with a screening,” she says.
See our sources:
Prevalence of colorectal cancer: American Cancer Society
Colonoscopy: National Institute of Diabetes and Digestive and Kidney Diseases
Effects of colonoscopy screening study: New England Journal of Medicine
Reliability of at-home tests: Gastroenterology & Hepatology
Screening recommendations: American Cancer Society
Cited sources were last reviewed on 5/28/2025
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