Colorectal cancer is cancer of the colon or rectum. It usually starts as a polyp, a small growth on the inner lining, that slowly changes over years. Screening looks for polyps and early cancer in people who feel well. Screening works because finding and removing polyps can stop cancer before it starts. If you are 45 or older and live in Los Angeles, this page will help you understand your choices.
When should I start colorectal cancer screening?
For adults at average risk, the US Preventive Services Task Force (USPSTF) and the American Cancer Society both recommend starting at age 45. You are at average risk if you have no symptoms, no personal history of polyps, colorectal cancer or inflammatory bowel disease, and no strong family history.
- Ages 45 to 75: screening is recommended for everyone at average risk.
- Ages 76 to 85: the decision is personal. It depends on your overall health, how long you are expected to live, and your past screening results.
- Over 85: screening is usually no longer recommended.
If you are in your mid-40s or older and have never been screened, now is a good time. You can read more about why the age dropped to 45 in our article colorectal cancer screening at 45.
What if my risk is higher?
Some people need to start earlier, need a colonoscopy rather than a stool test, or need exams more often. This usually applies if you have:
- A family history: a parent, brother, sister or child who had colorectal cancer or an advanced polyp. Screening often starts at age 40, or 10 years before the age your relative was diagnosed, whichever comes first.
- Inflammatory bowel disease: long-standing ulcerative colitis or Crohn's disease of the colon. Regular colonoscopies usually begin about eight years after symptoms start. See inflammatory bowel disease.
- Polyps or colorectal cancer in the past: you need surveillance colonoscopies (explained below).
- An inherited syndrome: such as Lynch syndrome or familial adenomatous polyposis, or a family history that suggests one. These need much earlier and more frequent exams.
If any of these apply to you, talk with Dr. Pimienta before choosing a home test. Your plan depends on your health; Dr. Pimienta will talk with you about what fits you.
I have symptoms. Is that still screening?
No. Screening is for people who feel well. If you have symptoms such as rectal bleeding, blood in the stool, a lasting change in bowel habits, iron-deficiency anemia, unexplained weight loss or ongoing belly pain, you need a diagnostic exam, usually a colonoscopy, whatever your age. Do not use a home stool test to "check" a symptom; a negative result does not rule out a problem.
What are my screening options?
For people at average risk, there is more than one good test. The right test is the one you will actually complete. Each option has a different schedule and a different level of effort.
| Test | What it is | How often (if normal) |
|---|---|---|
| Colonoscopy | A camera exam of the whole colon under sedation, with bowel prep. Polyps can be removed during the exam. | Every 10 years |
| FIT (fecal immunochemical test) | A home stool test that looks for hidden blood. No prep, no diet changes. | Every year |
| Stool DNA-FIT | A home stool test that looks for hidden blood and for DNA changes from polyps or cancer. | Every 1 to 3 years |
| CT colonography | A CT scan of the colon, sometimes called a virtual colonoscopy. It needs a bowel prep but no sedation. | Every 5 years |
| Flexible sigmoidoscopy | A shorter scope exam of the lower part of the colon only. | Every 5 years (or every 10 years with a yearly FIT) |
A positive result on any other test means you need a colonoscopy. A stool test, CT colonography or sigmoidoscopy can point to a problem, but only a colonoscopy can look at the whole colon and remove polyps. That follow-up colonoscopy is part of screening, so do not skip it.
How do I choose?
A colonoscopy takes more preparation, but if it is normal you are usually done for 10 years, and it can remove polyps on the spot. A stool test is easy and private, but you need to repeat it on schedule, and a positive result often leads to a colonoscopy that finds no cancer. Blood tests for colorectal cancer screening also exist; they are newer and less likely than other tests to find polyps before they become cancer. Dr. Pimienta can walk you through the trade-offs. Learn what the exam involves on our colonoscopy page.
What is surveillance after polyps?
If a colonoscopy finds polyps, your next exam usually comes sooner than 10 years. This is called surveillance. The timing depends on:
- How many polyps were removed
- Their size, especially whether any were 10 millimeters (about 0.4 inches) or larger
- Their type under the microscope, such as adenomas (the most common precancerous kind), serrated polyps, or hyperplastic polyps (which are usually harmless)
- Whether they were removed completely and how clean the prep was
As a general guide from the US Multi-Society Task Force, one or two small adenomas often mean a next colonoscopy in about 7 to 10 years, while larger polyps, many polyps, or polyps with more worrying features usually mean an exam in about 3 years or sooner. Dr. Pimienta reviews your pathology report and tells you when your next colonoscopy is due. If you are new to the practice, bring your past colonoscopy and pathology reports so he can set the right interval. Read more on our colon polyps page.
Is colorectal cancer rising in younger adults?
Yes. Overall rates have fallen in older adults, largely thanks to screening, but colorectal cancer has become more common in people younger than 55. The American Cancer Society reports that about 1 in 5 new cases in 2019 were in people younger than 55, up from about 1 in 10 in 1995. The reasons are still being studied. This is part of why screening now starts at 45, and why symptoms such as bleeding should be checked at any age.
What does Medicare cover?
Medicare Part B covers colorectal cancer screening, including screening colonoscopy and stool tests (FIT and stool DNA tests). If a Medicare-covered stool test is positive, Medicare also covers the follow-up colonoscopy as a screening test. How often Medicare pays depends on the test and on your risk.
One thing surprises many people: if a screening colonoscopy finds and removes a polyp, what you owe may change. Please ask us before your exam so there are no surprises. Dr. Pimienta accepts Medicare, including patients with a secondary (supplemental) plan. For other insurance, the practice is out of network and visits are self-pay; our team explains pricing before anything is booked. See insurance and payment.
How do I get started?
Whether you live near the office in Mid-Wilshire or elsewhere in Los Angeles County, you can start with a consultation in person or by video, then have your colonoscopy at the surgery center in Beverly Hills.
Request a visit
Use the appointment request form or call the office. Tell us if you have symptoms, a positive stool test, or a family history.
Gather your records
Past colonoscopy reports, pathology reports and stool test results help Dr. Pimienta decide which test you need and when.
Choose a test together
If a colonoscopy is the right choice, you get written prep instructions and a date at the surgery center.
Questions patients ask
I am 45 and feel fine. Do I really need screening?
Yes. Polyps and early colorectal cancer usually cause no symptoms. That is exactly why screening is done in people who feel well.
Is a home stool test as good as a colonoscopy?
For people at average risk, a stool test done on schedule is a reasonable choice, and any screening is better than none. A colonoscopy looks at the whole colon and can remove polyps, so it is the preferred test for people at higher risk and the required next step after a positive stool test.
My stool test was positive. What now?
You need a colonoscopy. A positive result does not mean you have cancer; it often comes from polyps or other causes. But only a colonoscopy can find out. Please do not wait or repeat the stool test instead.
My father had colon cancer. When should I start?
Often at age 40, or 10 years before the age he was diagnosed, whichever comes first, usually with colonoscopy. Dr. Pimienta will review your family history and set a plan.
I am over 75. Should I keep getting screened?
It depends on your health and your past results. Many people between 76 and 85 can make a personal choice with their doctor. After 85, screening is usually not recommended.
Can I do the consultation by video?
Yes, if you are in California at the time of the visit. Dr. Pimienta can review your history and help you choose a test by video. A colonoscopy itself is done in person at the surgery center.
References
- US Preventive Services Task Force. Colorectal Cancer: Screening. 2021.
- American Cancer Society. Guideline for Colorectal Cancer Screening.
- Medicare.gov. Colorectal cancer screenings: colonoscopies.
- Siegel RL, et al. Colorectal cancer statistics, 2023. CA: A Cancer Journal for Clinicians. 2023.
- Gupta S, et al. Recommendations for Follow-Up After Colonoscopy and Polypectomy: US Multi-Society Task Force on Colorectal Cancer. 2020.