Almost 30% of the UK population has a family history of bowel cancer, so having one is not unusual. What matters is the pattern. Some patterns need referral and colonoscopy surveillance, and for those a stool test is not the right tool. This page tells you which is which, including when we are not what you need.
Family history is not one thing. Guidance sorts it into risk categories, and the category determines whether you need surveillance colonoscopy or not. That distinction matters more than anything else on this page.
If one first degree relative was diagnosed under 50, or two first degree relatives were affected at any age, you meet criteria for at least moderate risk. That means referral and colonoscopic surveillance under BSG, ACPGBI and UKCGG guidance. A stool test is not a substitute for that, and we would rather say so than sell you one.
If your family history is weaker than that, a stool test is a reasonable thing to do. Heritable factors account for roughly 35% of bowel cancer risk, and a family history without an identified syndrome carries a two to sixfold increase over the general population. We report at 10 µg Hb/g and give you the actual number.
Please seek referral rather than ordering a kit if any of these describe your family:
These patterns are assessed in a familial bowel cancer or genetics clinic, and the answer is usually colonoscopy on a schedule rather than stool testing. Your GP can refer you. We can also discuss it in a consultation, but the destination is the same and we would be doing you a disservice by selling you a kit instead.
Drawn from the 2020 BSG, ACPGBI and UKCGG hereditary colorectal cancer guideline and NHS genomics guidance.
Which means having one, on its own, is unremarkable. Heritable factors account for roughly 35% of overall bowel cancer risk, but most people with an affected relative do not have an inherited syndrome.
One first degree relative diagnosed under 50, or two affected first degree relatives, meets criteria for at least moderate risk. That means referral and colonoscopic surveillance, not periodic stool testing.
Compared with the general population. Meaningful, and a long way short of the near certainty that inherited syndromes carry. Familial adenomatous polyposis, for comparison, carries a lifetime risk close to 100%.
Moderate risk under the guideline means a one off colonoscopy at 55. Higher risk means colonoscopy every five years from 40 to 75. Neither of those is something a home test replaces.
It is the most common inherited bowel cancer predisposition syndrome, and it is identified through genetic assessment rather than through any stool test. If it is in your family, that is a genetics referral.
This is the part most family history pages skip, and it is the only part that changes what you should do.
| Your family pattern | What guidance points towards |
|---|---|
| One first degree relative diagnosed at 50 or over, and no other affected relatives | Usually managed as average or low risk: the national screening programme from 50, plus acting on any symptoms |
| One first degree relative diagnosed under 50 | At least moderate risk. Referral and colonoscopic surveillance rather than stool testing |
| Two first degree relatives affected, any age | At least moderate risk. Referral and colonoscopic surveillance |
| A known syndrome in the family, many polyps, or several cancers across generations | Genetics referral. Assessment for Lynch syndrome or polyposis, and a surveillance plan built around the finding |
First degree means a parent, brother, sister or child. Grandparents, aunts, uncles and cousins are second degree, and they carry less weight in these criteria, though a striking pattern across them is still worth mentioning to a doctor.
Under the 2020 guideline, moderate risk typically means a one off colonoscopy at age 55, with anything found afterwards managed under post polypectomy surveillance rules. Higher risk categories are assessed individually and generally involve colonoscopy every five years from 40 until 75. Those numbers exist because colonoscopy can find and remove polyps before they become anything. A stool test cannot do that, and no amount of testing substitutes for it.
Most people with a family history do not meet those criteria. One relative diagnosed in their late sixties is a common situation and it is not, on its own, a route into a surveillance programme. If that is you, and you are outside the screening age range or between screening rounds, a stool test at the symptomatic threshold is a reasonable thing to do.
Two situations where it is particularly useful:
The same thing it means for anyone else, with one addition. The threshold is 10 µg Hb/g regardless of family history, because the test measures blood and blood is blood. What family history changes is the prior probability that a given amount of blood reflects something significant, and therefore how quickly and how thoroughly it should be chased.
That is the argument for having a doctor read your result rather than a website. A figure of 24 in someone with no family history and no symptoms is a different conversation from a figure of 24 in someone whose mother was diagnosed at 52, even though the number is identical.
Before your call, try to establish who was affected, what cancer they had, and roughly how old they were at diagnosis. Ages at diagnosis matter more than anything else in these criteria, and they are the detail people most often do not have to hand. Womb and ovarian cancers in the family are worth mentioning too, because they form part of the pattern that prompts a Lynch syndrome assessment.
If your history meets moderate or high risk criteria, the consultation will tell you to seek referral for colonoscopic surveillance, and we will put that in writing to your GP. That is a worse commercial outcome for us and a better clinical one for you, and there is no version of this where selling a stool test to somebody who needs a colonoscopy is defensible.
All from the 2020 BSG, ACPGBI and UKCGG hereditary colorectal cancer guideline and NHS genomics guidance.
Family history is the topic where the gap between what we sell and what some people need is widest. Here it is plainly.
It depends on their age at diagnosis and on how many other relatives were affected. A family history without an identified hereditary syndrome carries roughly a two to sixfold increase over the general population, but the important question is whether you meet criteria for surveillance. One first degree relative diagnosed under 50, or two affected first degree relatives at any age, meets criteria for at least moderate risk under the BSG, ACPGBI and UKCGG guideline. One relative diagnosed at 68 with no other affected relatives usually does not.
If you meet moderate or high risk criteria, colonoscopy on a surveillance schedule, arranged through referral. Moderate risk typically means a one off colonoscopy at 55, and higher risk categories generally involve colonoscopy every five years from 40 to 75. A stool test does not replace that, because surveillance colonoscopy exists to find and remove polyps before they become cancer and no stool test can do that. If your family history does not meet those criteria, a stool test is a reasonable step.
No. Lynch syndrome is the most common inherited bowel cancer predisposition syndrome and it is identified through genetic assessment, not through any stool test. If there is a known syndrome in your family, or a pattern of bowel, womb and ovarian cancers across generations, that is a genetics referral. Your GP can arrange it.
Not automatically. NHS screening invites people from 50 in England, Scotland and Wales and from 60 in Northern Ireland, and a family history does not by itself bring that forward. What does change things is meeting the moderate or high risk criteria, which lead to a separate surveillance pathway rather than to earlier screening. If you are under 50 with a family history that does not meet those criteria, you fall in a gap, and that is the situation this test is genuinely useful for.
First degree relatives, meaning parents, brothers, sisters and children, carry the weight in these criteria. Grandparents, aunts, uncles, nieces, nephews and half siblings are second degree and count for less on their own. That said, an unusual pattern across the wider family, or several related cancers across generations, is still worth raising with a doctor because it can point towards a syndrome that the simple criteria miss.
That is very common, particularly where relatives died young, records are incomplete, or you are adopted. Bring what you have. Ages at diagnosis matter most, then which cancer it was, then how closely related the person was. Where the history genuinely cannot be established, that uncertainty is itself a reason to have a conversation with a doctor rather than to make an assumption in either direction.
Figures are drawn from the sources above. Framing and commentary are the author’s own. Written and reviewed by Dr Rhea Bhadresha, GP. Last reviewed August 2026.
A consultation is included with every test. If your family history means you need surveillance rather than a stool test, we will tell you that and write to your GP.
Your exact FIT figure, a written GP report and a telephone consultation are all included, whatever the number turns out to be. A one-off test with no subscription and nothing recurring.