Colonoscopies are no fun. These at-home colon cancer screenings offer a shortcut.
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.
The budget-friendly original: an at-home FIT test
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.
The pooper scooper: Cologuard stool testing
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.
The blood draw: Guardant
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."
"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: Blood
How often: Once every three years
Cost: 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 involved
Cons: 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).
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He earns more than Lydia and works mostly for financial reasons, as taxes on his home and rising costs have burdened him and his wife. "Mentally and physically, I feel really good, and that's a blessing," Sparveri says. Still, he's concerned that many older people will continue to be hurt by rising prices and economic uncertainty. "People are suffering, and I don't want to put myself in that position." Love keeps them going through financial ups and downs One afternoon, Lydia searches every nook and cranny of the apartment in search of a CD by Bill's former jazz ensemble, recorded in 1996 with jazz pianist Bill Mays. He walks to a cabinet and pulls it out. She puts it into the CD player and starts dancing, humming the melody to the first track. Bill looks on with a slight smile. He started playing piano when he was 3, performed with a swing jazz band, and hosted an FM jazz radio show in Austin. "Most of those people are dead," Bill says of his old bandmates. "Well, you're not," Lydia quips. Bill and Lydia have lived in their current apartment for six of their nearly 30 years of marriage. This is Bill's second and Lydia's third marriage, and each has children from previous spouses. Lydia lost much of her savings in her 40s when her second husband abruptly closed one of the successful office and mail service stores they started together. He declared bankruptcy very shortly after. "It all went down the tubes," she recalls, noting she was able to get a previous job back shortly after. "I still don't know how I got through that." They didn't know each other at the time, but while Lydia was recovering from that financial setback, Bill was making $90,000 a year from performances and his work at the TV station. Lydia met Bill through a dating service in 1995. He picked her up for their first date in a white limousine, wearing a camel-hair coat. "I was going on dates with three women at the time, but when I saw her, I dropped them all," Bill says. "He had glasses three times bigger than he needed, which I took care of," Lydia jokes. Like any marriage, theirs has had its ups and downs. After a brief stint in Florida, they returned to Connecticut and spent most of their savings on a house that required more repairs than they had expected. Lydia had moved on from the now-closed mail stores and was working as a real estate agent, but says she rarely made enough money to be comfortable. Bill had left the TV station in 1994 to focus on his band and was playing at weddings, teaching piano lessons, and selling pianos. They had been able to save a little throughout their career, but never enough to think they could retire. "We put almost all of our money into that house," Lydia says. She says they bought it for $185,000 in 2002 and spent more than $100,000 on renovations. "It looked a lot better, and we figured we'd flip it and do OK." Then the 2008 recession hit "like a ton of bricks," Bill says. At the time, they had $75,000 invested in the market, but as the market fell, they pulled from their account to pay for their increased mortgage and property taxes. The couple hoped they'd get some money out of the home they'd renovated. But they defaulted on their mortgage in 2015, and a forced sale brought only $115,000. They filed for bankruptcy. The income from a side business Lydia had started to help people downsize their homes, and the piano lessons that Bill gave, weren't enough. They were among the more than 10 million Americans who lost their homes due to the Great Recession. The S&P 500 took over five years to fully bounce back after dropping more than half its value from its high in 2007 to its lowest point in 2009. For thousands of households approaching retirement age, this meant working longer after their savings shriveled. "I take a lot of responsibility. We've made mistakes, but also, who knew a recession was coming?" Bill says. "We all make mistakes, honey," Lydia says. While Americans on average are saving close to the recommended 15% of their income for retirement, many in their 80s and 90s grew up before financial education and 401(k)s were prevalent. Not saving enough was a common regret among the over 3,800 older Americans who shared with BI their retirement regrets and what aspects of their lives they would redo if they had the chance. Maura Porcelli, a senior director at the National Council on Aging, says the organization "saw people who thought they had done their due diligence in planning for retirement, the sort who thought their monthly budgets were going to be sufficient, who had all those hopes dashed." "We know that a good number of older adults are susceptible to a major life event that can knock out a major chunk of their savings," she says. According to the Federal Reserve's Survey of Consumer Finances, the bottom fifth of households headed by someone 75 and older had a net worth of about $75,000 in 2022, including equity built up in their homes. For now, the Hindses are bracing for another life-shattering event. "If I lose her, I don't know what I'm going to do," Bill says. "She feels the same way." Working to survive and holding on to each other Some days after work, Lydia sits at her computer and applies for any job she could reasonably do. She tries to appear as sprightly as possible in her applications, sometimes emphasizing how she graduated from the University of Hartford mid-career in 1994. Though she omits her age from her résumé, she suspects that employers have been able to tell, preventing her from landing anything higher-paying than Home Depot. To counter her many rejections, she started building an online business selling funny gift cards, bags, and clothes. She hired a company to design her website, which cost a few hundred dollars. She works with a print-on-demand company to secure merchandise. She hopes it will take off enough that she can work fewer hours at Home Depot. There is little concrete data about the prevalence of potential ageism among workers in their 80s. Companies are prohibited from age discrimination against workers 40 and older per the Age Discrimination in Employment Act. Many of the dozens of workers BI spoke with say they suspected their age hindered their progress at work or hurt their job applications. "Managers are already thinking that 60 is too old, so there's little hope for someone who is much older," says Janine Vanderburg, who founded the anti-ageism nonprofit Changing the Narrative. "Many of the job boards for older workers are focused on lower-paid jobs where there's a demand. If you cannot pay your mortgage, your rent, whatever it is, and you need to work, it's better to do something than nothing." Though programs like the Senior Community Service Employment Program help lower-income Americans 55 and older get job training, the two dozen aging and work researchers and organization executives BI spoke to agreed there should be more resources for older Americans in the workplace. This could include more conversations with workplace leadership about advocating for older workers, more training on technology topics like AI, or local legislation codifying more protections against ageism. Lydia and Bill hope to move out of their apartment before their rent rises again. It's increased by nearly $300 a month since they moved in 2019, but they have nowhere to go. They're waiting for an open cottage at a nearby care facility, which would cost $1,650 for a one-bedroom unit, but they've rethought whether that would be feasible financially. "I want to be in a place where if something happens, we're still together — or at least we can visit each other easily," Lydia says. With all the financial strain, some days, Lydia wants to give up and say, "The hell with it." The couple attributes their longevity to their connection. They say they rarely fight, and when they do, it ends with laughs and comfort. "We're soulmates," Lydia remarks, pointing to Bill. Their relationship is vital because many people in their community, she says, are not well enough to live active lives. Plus, Lydia no longer speaks to her daughter after years of a souring relationship. Bill's relationship with his children is tighter. For his 90th birthday, most of his family flew to Connecticut. They're about to become great-grandparents. It's hard to maintain friends on a budget, Bill says. They've set aside some money to visit a friend on Cape Cod in October, and Bill has plans to see a film with a friend. One of the downsides of aging, he says, is losing friends left and right. Many have died, while others have drifted away. Their Christmas dinner table of 10 a few years ago has dwindled to just three. Amid financial frustrations and loneliness, they find moments of solace. Now and then, they drive the half hour to Hartford in their 2023 Hyundai Elantra for a concert or to the shore with their dog. But often, it's the little moments that distract them from their financial anxiety. For the first time in five years, Bill sits at the piano in their community's clubhouse. He strikes a few chords, cringing as the notes sound slightly too dissonant for his liking. "I have perfect pitch," Bill says. "When I shout, he can tell me what note it is," Lydia whips back. From memory, he plays selections from Claude Debussy's "Clair de Lune" and Frédéric Chopin's "Nocturnes," missing a note here and there to his frustration. Tears stream down Lydia's face as he serenades her with the out-of-tune piano. When he finishes a prelude, she hugs him tightly. It's moments like these that keep her going, she says, holding his hand on the walk back home. Once there, Lydia takes a green binder and places it on her coffee table. In it are 30 pages of notes in preparation for a September trip to New York City for Bill's 91st birthday. A dozen pages are devoted to receipts, directions, and other logistics, like a fancy Italian dinner at Carmine's and a $550-a-night hotel room on Broadway. But given their finances, they've canceled the dinner and are just doing a day trip without a hotel stay. They want to save for Lydia's birthday in August. "I wanted to do something special, but we can't swing it," Lydia says, grabbing a tissue to wipe her eye. "A lot of people don't make it to 91." One page sticks out. It's a receipt for the Broadway musical "Buena Vista Social Club": Two front-row balcony tickets cost her $700. She's paying $50 a month through November via a buy now, pay later app. Bill has long loved the music, and though the tickets were out of their budget, she says it's worth it. For just a day, they will feel wealthy. Nothing, not even the medical bills protruding from her desk, her dwindling paystubs, or a dozenth new medication, would get in the way of that.
