Colorectal screening

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.

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.

Unknown family history. Not having access to your family’s medical history does not by itself rule out the routine FIT pathway. This differs from knowing that a parent, sibling or child had colorectal cancer but not knowing their age at diagnosis. In that case, ask a clinician to help clarify the right starting age and test.

Ages 75–85. Screening is not routine, but some people may benefit after an individual discussion. Your provider considers your health, previous screening, and whether you are willing and able to have a follow-up colonoscopy. Routine screening is not recommended after 85. This does not cancel diagnostic assessment or an existing specialist follow-up plan.

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 (811) can help you find a provider. Ontario also mails invitation letters to eligible people. See Getting screened.

You do not need to wait for an invitation letter before asking about screening if you meet the eligibility criteria.

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 is collected with the kit. Follow the return instructions supplied with it. Current In-Common Laboratories (ICL) kits use a prepaid mailing envelope or an approved Rexall drop-off location; kits supplied by a nursing station or health centre may have local return instructions. See the current FIT instructions rather than taking the sample to an unspecified laboratory. 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.

Return your completed sample as soon as possible. Follow the storage and return instructions that came with your specific kit.

What happens after an abnormal result

A positive FIT means blood was detected, not that you have cancer; the next step is colonoscopy. Contact your healthcare provider promptly to arrange it. Ontario recommends completing colonoscopy within 8 weeks of an abnormal FIT result. This is a recommended timeframe, not a guaranteed booking; do not wait to start arranging follow-up. Do not repeat FIT to try to cancel out an abnormal result. 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

• Colon cancer testing and prevention — Ontario Ministry of Health
• Colon cancer screening eligibility is changing in Ontario — Ontario Health
• Colorectal Cancer Screening Recommendations Summary — Ontario Health / Cancer Care Ontario
• FIT collection, return and follow-up instructions — Ontario Health / Cancer Care Ontario

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