Renee Williams, MD, MHPE

Colorectal Cancer Screening Explained: Colonoscopy, FIT, and What Comes Next

Despite decades of public health messaging and clear evidence supporting the benefits of screening, colorectal cancer screening rates in the United States remain below national targets. During Colorectal Cancer Awareness Month, gastroenterologists are emphasizing both the progress made and the work that still lies ahead to improve early detection of colorectal cancer.

National initiatives have long aimed for screening rates of 80%, but uptake continues to fall just short of that benchmark. Current estimates generally place screening participation somewhere in the mid-to-high 70% range, with significant variation depending on the population and data source. According to Renee Williams, MD, an associate professor in the department of medicine at NYU Langone, those numbers highlight both success and persistent gaps in prevention efforts.

“We've had this 80% goal for a very long time, but we’re not fully there,” Williams said.

A key component of effective screening is understanding patient risk. Family history remains one of the most important factors guiding screening decisions. Patients with a first-degree relative diagnosed with colorectal cancer are considered higher risk and should undergo colonoscopy rather than noninvasive tests.

For average-risk individuals, however, several screening options are available. Noninvasive stool-based tests, including fecal immunochemical testing (FIT), offer a convenient alternative for patients who may be reluctant to undergo colonoscopy. For clinicians, Williams says the guiding principle is simple: the most effective screening test is the one the patient actually completes.

Still, she stresses that colonoscopy remains essential in many situations. Patients presenting with symptoms such as rectal bleeding, unexplained weight loss, or abdominal pain should undergo diagnostic colonoscopy rather than screening tests. Similarly, Williams says those with elevated risk due to family history are generally not appropriate candidates for stool-based screening.

Barriers to screening are complex and multifactorial. Access to care, limited patient awareness, and anxiety about testing all play a role. Many patients may also be unaware of their family history or individual risk factors. Because of this, Williams emphasized the importance of clinician-patient conversations about screening and prevention.

System-level strategies can also make a measurable difference. Research has shown that patient navigation programs and mailed screening outreach, such as sending FIT kits directly to patients, can significantly improve screening rates, particularly in vulnerable populations.

Looking ahead, Williams says emerging technologies could reshape the screening landscape. Blood-based screening tests are generating excitement because of their simplicity, but their role within existing screening strategies is still being defined. At the same time, researchers are exploring more personalized approaches that use risk models to tailor screening methods to individual patients.

National Colorectal Cancer Roundtable. Colorectal Cancer Is A Major Public Health Problem. August 5, 2025. Accessed March 9, 2026. 

https://nccrt.org/our-impact/data-and-progress/

May F. The Nuances of Noninvasive Screening for Colorectal Cancer, with Fola May, MD, PhD. HCPLive. April 22, 2025. Accessed March 9, 2026. 

https://www.hcplive.com/view/the-nuances-noninvasive-screening-colorectal-cancer-with-fola-may-md-phd

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Williams explains colorectal cancer screening options, persistent barriers to uptake, and strategies to improve screening rates.

Renee Williams, MD, MHPE

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