Colon cancer is one of the most common cancers, and it’s also one of the most preventable. As clinicians, we know that early detection saves lives, but many patients hesitate to get screened — often because they aren’t aware of their options or feel overwhelmed by the process. Conversations about colon cancer screening should be clear, compassionate, and patient-centered. One of the best ways to guide these discussions is by making the process relatable. I often tell my patients, "Screening is like checking your car’s engine before a long road trip. You might not notice any problems, but wouldn’t you rather catch an issue early instead of being stranded on the side of the road?" This simple analogy helps patients understand that screening is about prevention, not just diagnosis.
Starting the Conversation
The first step in discussing colon cancer screening is to listen. Ask open-ended questions like, "What have you heard about colon cancer screening?" or "Do you have any concerns about getting tested?" These questions often reveal underlying concerns — discomfort, embarrassment, fear of a cancer diagnosis, or confusion about the process. Patients may also believe that colonoscopy is the only option, which can be intimidating. Clarifying that there are multiple ways to get screened opens the door to a more collaborative discussion.
For patients who say, "I feel fine, so why do I need this?" I explain that colon cancer can be a silent disease, developing without symptoms until it's advanced. I remind them that the goal of screening isn’t just to catch cancer early but to prevent it altogether by removing precancerous polyps. Framing the conversation around prevention, rather than just detection, can be a game-changer in patient acceptance.
Navigating the Options
There is no one-size-fits-all approach to colon cancer screening. Each option has its benefits and drawbacks, and the "best" test is the one the patient is willing and able to complete. Patients who are hesitant about invasive procedures might prefer non-invasive stool tests, while others may opt for a colonoscopy to avoid the hassle of frequent testing.
Stool-based tests like the fecal immunochemical test (FIT) and fecal occult blood test (FOBT) are convenient. These tests check for hidden blood in the stool and need to be done annually. While simple, they come with the caveat that a positive result means the patient will need a follow-up colonoscopy. It’s important to clarify that these tests are screening tools — they can detect potential signs of cancer, but they don’t prevent it.
Another option, the stool DNA test (such as Cologuard), screens for genetic markers associated with colon cancer and can be done every three years. Patients often appreciate that it’s noninvasive and requires no bowel prep. However, it is important to caution them about the possibility of false positives and the need for follow-up if something abnormal is found. Like other stool tests, it’s designed to identify cancer early, not to prevent it from developing.
Then, there’s the colonoscopy, the gold standard for screening — and importantly, the only test that is both screening and preventive. During a colonoscopy, we can find and remove polyps before they become cancerous. I often use the analogy of tending a garden: "Think of polyps like weeds in a garden. A colonoscopy allows us to pull them out before they grow and spread. Stool tests, on the other hand, are like looking over the fence to see if weeds have already taken over. Both methods are useful, but only pulling the weeds prevents problems down the road." This analogy helps patients grasp why colonoscopy plays a unique role in prevention.
That said, colonoscopy isn’t without its drawbacks — bowel prep, sedation, and the potential for rare complications like bleeding or perforation. For some patients, those concerns are significant barriers. That’s when I reassure them that other effective options exist, especially if they’re unlikely to follow through with a colonoscopy.
Flexible sigmoidoscopy and CT colonography offer additional alternatives but come with limitations. Flexible sigmoidoscopy examines only the lower colon, and CT colonography, while non-invasive, still requires bowel prep and exposes patients to radiation. These options can be valuable for patients unable to undergo a full colonoscopy.
Addressing Barriers and Motivating Action
It’s common for patients to stall at the idea of bowel prep. I acknowledge their concerns honestly: "It’s not pleasant, but it’s manageable — and a small price to pay for peace of mind." Offering tips — like chilling the prep solution or using a straw — can make the process seem less daunting.
Fear of results is another hurdle. I remind patients that most screenings come back normal, and if something is found, catching it early dramatically improves treatment options and outcomes. Sometimes, putting it into perspective helps: "Wouldn’t you rather find a tiny spark and put it out instead of waiting for a fire to spread?"
Patients often ask, "If there are so many options, how do I choose?" I guide them by asking what matters most — convenience, accuracy, or avoiding procedures. Some patients prioritize avoiding invasive tests, making stool-based options a better fit, while others prefer the longer screening interval that colonoscopy offers. The key is to empower them with information while supporting their decision.
Creating a Plan and Following Through
Once a patient selects a screening option, make the next steps as seamless as possible. For home-based tests, walk them through how to use the kit and set up a system to check in on completion. For colonoscopies, ensure they understand how to prepare, schedule transportation, and plan for post-procedure recovery. Follow-up is crucial, especially if results are positive or if patients are prone to procrastination. A simple "Just wanted to check if you were able to complete your test" can be the nudge they need.
The best screening test is the one they’ll actually do. So, let’s help them choose it — and get it done.
What are some tips and tricks you use to discuss screening tests and preventative care with your patients? Share in the comments!
Iqra Qazi, MD, is a second-year internal medicine resident Beaumont, TX , with aspirations of specializing in gastroenterology. She is dedicated to providing patient-centered care and advancing her clinical skills through continuous learning. Outside of medicine, she enjoys traveling, spending time with her family, and exploring ways to maintain work-life balance during residency.
Illustration by April Brust
