Getty Images; Alyssa Powell/BI
- Colon cancer is the second-deadliest cancer in the US, partly due to low screening rates.New and emerging screening tools, like blood and breath tests, may offer alternatives to in-office screenings.This article is part of "Transforming Treatments," a series on medical innovations that save time, money, or discomfort.
Colon cancer is the second-deadliest cancer in America. It's not deadly because it's particularly hard to treat or because oncologists are bad at spotting it. In large part, it's because people aren't getting their colon checked out often enough.
Only about 1 in 5 adults who are between the ages of 45 and 49 is up to date on their colon cancer screening (older adults fare better, with around 7 in 10 completing it).
"This is a highly preventable disease and we have to change the status quo so that people don't die," Dr. Paul Limburg, a gastroenterologist and chief medical officer at Exact Sciences, the company that makes one of the most popular do-it-yourself colon cancer screening tests, told Business Insider.
A colonoscopy is still the most reliable tool, both for spotting colon cancer and for serving double duty as a colon-cleanup service. "I would still choose a colonoscopy for myself," Dr. Tim Cannon, a medical oncologist who directs the gastrointestinal cancer program at the Inova Schar Cancer Institute, told BI.
"It is considered the gold standard, you can detect precancerous polyps and take them out during the procedure, and you can do it less often" than DIY tests, Cannon said.
However, a new suite of at-home tests is rapidly expanding.
For those struggling to find an appointment, those who don't have great insurance, or those who are just squeamish about colonoscopies, there are some pretty painless precursors you can do to check things out.
Some recently-approved tests check your blood or your stool for signs that something is awry. One highly anticipated test, which isn't out yet, may require nothing more than your breath.
Here are four of the latest and greatest colonoscopy alternatives:
The budget-friendly original: an at-home FIT test
LetsGetChecked
The fecal immunochemical test (aka FIT) has been around since the 1980s and is still a recommended screening tool today because it's cheap, relatively reliable, and requires no preparation.
"Fecal-immuno test is the most inexpensive," Dr. Asad Umar previously told BI. "People don't like to do it, because — maybe it's the 'yuck' factor — but this could be lifesaving."
You typically perform the FIT in your bathroom after a bowel movement by collecting some stool out of the toilet bowl with a brush. After the kit is sent to the lab, it will be checked for hidden blood in the stool — an early colon cancer symptom.
Since colon cancers don't constantly let out blood in your stool, the test isn't perfect. FIT is about 75% accurate at detecting colon cancer cases, and a smaller number of people (about 1 in 20) may get a false positive result when they don't have colon cancer.
- Method: StoolHow often: Once a yearCost: Prescriptions are free for everyone over 45 with insurance. Over-the-counter costs can range from $25-80.Pros: Easy to do at homeCons: May miss around 25% of cases
The pooper scooper: Cologuard stool testing
Cologuard
Like FIT, Cologuard is a stool test that you do in the bathroom, and then send into a lab for testing. Unlike FIT, Cologuard looks for both blood and cancerous DNA in your poop.
Adding DNA to the mix makes Cologuard more successful: it picks up more than 9 in 10 colon cancer cases, and can flag some precancerous polyps. The downside is that Cologuard also sometimes flags poop samples that aren't cancerous, with roughly 1 in 10 patients receiving a false positive test reading.
Anne Jones, a collegiate athlete career coach, was 46 when she first tried Cologuard. She knew that more women her age were being diagnosed with late-stage colon cancers, but she was hesitating about when to schedule her first colonoscopy. Did she really need to do this right now? A colonoscopy procedure requires several hours of prep work at home, emptying out your colon with heavy-duty laxatives. It's performed under anesthesia, so you need someone to pick you up from the hospital afterward.
"It was less the fear of the colonoscopy and more just the hassle," Jones said. When her doctor explained she could order a Cologuard test and do it on her own at home with zero prep, it seemed like a no-brainer.
"The doer in me is like 'great, let's do it.' I want to get this done. Cross it off the list."
Crossing her colon cancer screening "off the list" ended up taking a few more steps, though, because Jones's Cologuard test came back positive. Within a few months, Jones went in for a colonoscopy, which found and removed multiple pre-cancerous polyps in her colon.
"It was not cancer, but there were three polyps that were pre-cancerous," Jones said. She said she's glad she was given the nudge to go under, though. "It just begs the question, if I had waited a year, might that have been different?"
Cologuard, made by Exact Sciences, was first approved in 2014. In late 2024, the US Food and Drug Administration approved Cologuard Plus, which is more accurate than the regular Cologuard test and detects around 95% of colon cancers.
- Method: StoolHow often: Every three yearsCost: May be free with insurance. Out-of-pocket, around $650.Pros: Easy to do at homeCons: Price and possibility of false positives
The blood draw: Guardant
Guardant Health
Guardant Health has a new cancer screening test that skips the toilet and goes straight to your blood, analyzing your DNA for tell-tale clues that cancer could be lurking.
"What you're detecting is an abnormal molecule that is only created by a cancer," Guardant's Chief Medical Officer Dr. Craig Eagle told BI. "The more we learn what that looks like, the more we can actually find smaller and smaller amounts."
Guardant's first colon cancer blood test, called Shield, was FDA-approved in July 2024. It's part of the company's suite of "liquid biopsies" that use blood to help doctors gain insights about cancer, whether for cancer diagnosis or in later stages to inform cancer treatment decisions.
Guardant CEO Helmy Eltoukhy told BI he hopes that Shield can soon be harnessed to identify even more cancers, including some that are notoriously hard to detect, like pancreatic cancer. One federally funded study is recruiting 24,000 people across the US to test out Shield on multiple cancers.
"That's the beauty of this test: think of it as your iPhone, where initially it only had a few features. Over time, it has a thousand features," Eltoukhy told BI.
Patricia James, now 77, was one of the first patients to try Shield in Guardant's pivotal clinical trial that ultimately led to its FDA approval last year. As a cancer survivor with a family history of colon cancer, she is a big believer in preventative care. But she doesn't really like colonoscopies, having had a rare but really bad experience during her first, when she woke up halfway through the procedure, and started "crashing around" on the operating table.
After that, she said, she essentially swore off colonoscopies. She's getting older and has a greater risk of internal tearing and other rare complications from the procedure. So when her doctor mentioned there was a blood test available to screen for colon cancer, she said "sure."
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"There was no extra doctor's visit or anything," James told BI. She did it while she was in for a regular mammogram visit. She's now a huge advocate for the test, and even gave video testimony to Congress before it was FDA-approved.
"Look, I don't ever wanna mess around with my health, I've lost people to cancer and I battled it myself," she told the lawmakers. "I'm someone who wants all the time in the world to keep living. I have sung the praises of this test to friends and look forward to getting it again."
Like the other screening tests mentioned here, Shield does have a risk of false-positive and false-negative results, but those inaccuracies decrease as cancer progresses. In other words, the further along cancer is, the better the test is at detecting it.
- Method: BloodHow often: Once every three yearsCost: Generally covered by insurance for those over 45, and by Medicare for older adults. The test costs around $1,500 out-of-pocket.Pros: No poop involvedCons: Requires a doctor's visit to collect blood. Also, roughly 1 of every 10 patients who don't have colon cancer may receive a false positive result, and 1 in 6 who do have cancer may receive a false negative.
The breath test for colon cancer
Imagine that instead of collecting blood or poop to screen for colon cancer, all you have to do is breathe out for a few minutes.
Several companies, in the UK, US, Canada, and Israel are working on innovative cancer screening tests that would pick up on volatile organic compounds in your breath. It's essentially like an emissions test for cancer.
While none of these are available yet, the Israeli-based startup SpotitEarly is hoping to make its test available to consumers in the US as early as 2026, if all goes well with FDA regulators. A company-sponsored study published in November suggests the test is about 86% effective at picking up early-stage colon cancer cases (Stage 1 and 2).
- Method: BreathHow often: Not clear yetCost: Not available yetPros: Arguably the easiest test to perform, you just breathe for three minutesCons: It is not yet validated by the FDA, so it's unclear how well it can work. The goal is to detect cancer earlier than other tests.
