The advice is straightforward. If you’re 45, get screened, and don’t delay. If you’re under 45, and have a family history of colorectal cancer or polyps, talk to your doctor. And no matter your age, know what symptoms to look out for: blood in your stool, severe pain in your anus, sudden changes in bowel movements (like new, persistent constipation or diarrhea), iron deficiency, anemia, weight loss, and fatigue. “Go see a gastroenterologist and push for a colonoscopy,” Dr. May says.

Easier said than done, of course, especially for a young person whose doctor may dismiss or minimize concerns due to their age. This is one of the bigger issues in adequate colorectal cancer awareness and care, Michael Sapienza, CEO of the Colorectal Cancer Alliance, tells SELF. In the US, the majority of young people have to be seen by two doctors before they’re taken seriously about colorectal cancer. Some have to see up to four.

Cost and access make things harder. Colonoscopies are typically covered by insurance only after 45 or when symptoms are severe. Specialists aren’t available everywhere. And even among those who are eligible, many avoid screening—because it feels intimidating, inconvenient, or embarrassing. As of 2022, only 61% of adults aged 45 to 75 were up to date on screening.

So while colonoscopies are “the gold standard,” in Dr. Nazareth’s view, for people not at high risk for colorectal cancer, “any test is a good test. It doesn’t matter if it’s [a] colonoscopy.” Cologuard, for example, an FDA-approved fecal test, while not a replacement for a colonoscopy is an effective tool to screen for colon cancer.

Reframing colonoscopies

For a long time, colonoscopies have been the punchline of aging jokes. But most people who’ve had them say the reality isn’t that bad.

The prep is usually the most intimidating: A clear liquid diet the day before your colonoscopy plus drinking several liters of water mixed with powdered medication that clears your bowels. Bell and Beran have lots of little tips that can make it better, like popping the liquid in the fridge to make it cold, proactively using hemorrhoid cream, and booking your colonoscopy after 11 a.m. so you don’t have to take your second dose of prep medication in the middle of the night.