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Regular screening for colon and rectal cancer is now recommended for most men and women over 50. People who are at high risk of colon or rectal cancer can get tested earlier and more often.

Men and women are advised to follow one of these five testing plans from age 50:¹

• Fecal occult blood testing (FOBT) or a fecal immunochemical test (FIT) every year
• Flexible sigmoidoscopy every five years
• FOBT or FIT every year as well as flexible sigmoidoscopy every five years
• Double-contrast barium enema every five years
• Colonoscopy every 10 years.

To learn more about these tests, see What will happen to me during my test?

Medicare covers screening in people over age 50. This includes:²

• FOBT every year
• Flexible sigmoidoscopy every four years
• Colonoscopy every 10 years (but not within four years of a flexible sigmoidoscopy)
• Barium enema every four years (instead of colonoscopy or flexible sigmoidoscopy).

These screening plans are for men and women who have an average risk of getting bowel cancer. This means they have no health problems or family history that puts them at higher risk of bowel cancer. Men and women at higher risk are screened earlier, and usually more often.

Things that increase your chance of getting a disease are called risk factors.

You will be advised to get screened earlier and more often if you have any one of these risk factors for bowel cancer:¹

• You've had colon or rectal cancer before. You should have a colonoscopy three years after surgery, then every five years.
• You've had adenomatous polyps before. These are the type of polyp that are most likely to turn into cancer. You should have colonoscopy every three to five years.
• You have a strong family history of colon or rectal cancer or polyps. This means that a close relative (parent, child or sibling) had cancer or polyps before they were 60, or two close relatives had cancer or polyps at any age. If you have a strong family history, you should have a colonoscopy every 10 years or a double-contrast barium enema every five years. You should start having screening when you're 40, or 10 years before your youngest affected family member got cancer, whichever is earlier.³
• You have ulcerative colitis. This is a long-term (chronic) disease that causes inflammation inside the bowel. You should be offered colonoscopy every one to two years. You should start screening seven to 15 years after you got the illness, depending on how bad it is.³
• You have a family history of familial adenomatous polyposis. This is a rare disease that runs in families and causes lots of polyps to grow in your bowel. You should start screening at puberty and you should be offered flexible sigmoidoscopy every one or two years.³
• You have a family history of hereditary non-polyposis colon cancer. This is an inherited problem with your genes that makes colon or rectal cancer much more likely. You should have colonoscopy every one to three years from age 21.³

This information is for educational use only, and is not a substitute for prompt professional medical advice. Readers should always consult a physician or other professional for advice and treatment. ©BMJ Publishing Group Limited 2008. All rights reserved.