Screening guide › Colorectal screening
Colorectal screening
FIT every 2 years from 45 to 74 for average-risk people (since July 1, 2026), with colonoscopy pathways for increased family-history risk and individualized follow-up for other conditions.
- Average risk
- Ages 45–74: FIT every 2 years (as of July 1, 2026).
- Increased family-history risk
- One first-degree relative diagnosed before 60, or two or more at any age: colonoscopy every 5 years from age 40 or 10 years before the youngest relative's diagnosis, whichever is earlier.
- Individualized pathways
- Previous colorectal cancer, Crohn disease involving the colon, ulcerative colitis, surveillance polyps, hereditary syndromes, a positive FIT awaiting follow-up, or iron-deficiency anemia under investigation.
- Access
- Family doctor/NP, or Health811 (811) for a FIT kit if average risk 45–74 without a provider.
What this page helps with
Colorectal screening looks for hidden blood or early changes in people without symptoms. This page helps you work out which Ontario pathway fits your history — routine FIT, the family-history colonoscopy pathway, or individualized surveillance — and how to access it. It does not tell you whether you are due; that depends on the date and result of any previous FIT or colonoscopy.
Symptoms are not screening. If you have new or concerning symptoms, arrange assessment rather than a screening test. Severe or life-threatening symptoms: call 911 or go to the nearest emergency department; otherwise a provider, walk-in or urgent care clinic, or Health811 (811).
Who the routine guidance is for, and who needs another pathway
Average risk (FIT). As of July 1, 2026, Ontario recommends a FIT kit every 2 years for people ages 45–74 who have no symptoms, no personal history of colorectal cancer, no Crohn disease involving the colon, no ulcerative colitis, no polyps requiring surveillance, and no known hereditary syndrome — and whose family history is either none, or one first-degree relative (parent, sibling or child) diagnosed at 60 or older. Family history limited to polyps or to second-degree relatives does not by itself change this.
Increased family-history risk (colonoscopy). One first-degree relative diagnosed before 60, or two or more first-degree relatives at any age: colonoscopy is generally every 5 years, starting at 40 or 10 years before the youngest affected relative's diagnosis, whichever is earlier. If you are younger than that start, it is still worth planning now. If you do not know the relative's age at diagnosis, discuss the start with your clinician rather than guessing.
Individualized pathways (not routine FIT). Previous colorectal cancer, Crohn disease involving the colon (Crohn disease elsewhere is assessed individually), ulcerative colitis, polyps requiring surveillance, and known or suspected hereditary syndromes such as Lynch syndrome or FAP need surveillance planned with a specialist, and hereditary syndromes usually involve a genetics service. A positive FIT awaiting follow-up, or iron-deficiency anemia under investigation, needs diagnostic work-up — a new FIT is not the way to investigate either. Irritable bowel syndrome (IBS) is not inflammatory bowel disease and does not by itself change routine screening. None of these pathways ends at the routine FIT age cut-off.
How to access it in Ontario
Ask your family doctor or nurse practitioner for a FIT kit or a colonoscopy referral. If you are average risk, 45–74, and have no provider, call Health811 (811) to access a free FIT kit. Health811 cannot book a colonoscopy; the increased-risk pathway needs a clinician referral, and Health Care Connect (1-888-579-6707) can help you find a provider. Ontario also mails invitation letters to eligible people. See No family doctor?.
Potential benefits and limitations
Screening can find cancer early and, through colonoscopy after a positive FIT, find and remove polyps before they become cancer. Limitations: FIT misses some cancers and polyps; a positive FIT often turns out not to be cancer but still needs colonoscopy; colonoscopy carries small risks (bleeding, perforation) and needs bowel preparation. Screening does not replace assessment of symptoms such as rectal bleeding or a change in bowel habit.
What the test involves
FIT is done at home: a small stool sample collected with the kit and returned by mail or to a lab. No diet change or bowel preparation is needed. Colonoscopy is done in a hospital or clinic under sedation after bowel preparation; a flexible camera examines the whole colon and polyps can be removed during the procedure.
What happens after an abnormal result
A positive FIT means blood was detected, not that you have cancer; the next step is colonoscopy, usually arranged through your provider or the program. After colonoscopy, the findings determine whether you return to routine FIT or need surveillance colonoscopy at an interval set by the specialist. This page cannot interpret your result.
Questions to ask your provider
- Based on my family history, am I average risk or on the colonoscopy pathway — and at what age should I start?
- When was my last FIT or colonoscopy and when is the next due?
- My relative had colorectal cancer — do I know their age at diagnosis?
- I have a bowel condition — which pathway applies to me?
Sources and when they were checked
- R01 — Colon cancer testing and prevention, Ontario Ministry of Health.
- R02 — Colon cancer screening eligibility is changing in Ontario (July 2026), Ontario Health.
- R03 — Colorectal Cancer Screening Summary, Cancer Care Ontario / Ontario Health.