At what age should regular screening for colon cancer using colonoscopy (colonoscopy) start in individuals at low to average risk?

From the Guidelines

Regular screening for colon cancer among individuals at low to average risk using colonoscopy should start at age 45. This recommendation is based on the most recent and highest quality study, which suggests that starting screening at age 45 can help reduce the incidence of colorectal cancer and mortality among younger adults 1. The American Cancer Society, American College of Gastroenterology, and US Multi-Society Task Force on Colorectal Cancer all recommend starting screening at age 45 for average-risk individuals 1.

Key Points to Consider

• Screening should continue until age 75 for most people, with decisions to continue beyond that age made on an individual basis 1.
• The colonoscopy procedure should be repeated every 10 years if results are normal 1.
• Alternative screening methods include stool-based tests (FIT or gFOBT annually, or FIT-DNA every 1-3 years), flexible sigmoidoscopy (every 5-10 years), or CT colonography (every 5 years), though these may require follow-up colonoscopy if results are positive 1.
• Individuals with family history of colorectal cancer or certain genetic conditions may need to begin screening earlier or undergo more frequent examinations 1.

Rationale for Recommendation

The recommendation to start screening at age 45 is based on the increasing rates of colorectal cancer among younger adults 1. Colonoscopy is considered the gold standard for screening as it allows for direct visualization of the entire colon and removal of precancerous polyps during the same procedure 1. The US Preventive Services Task Force also recommends screening for colorectal cancer in adults aged 45 to 49 years, with a Grade B recommendation 1.

Important Considerations

• Life expectancy and overall health should be considered when deciding whether to continue screening beyond age 75 1.
• Patient preferences and prior screening history should also be taken into account when making decisions about screening 1.

From the Research

Screening Age for Colon Cancer

• The recommended age to start regular screening for colon cancer among individuals at low to average risk using colonoscopy is 45 years old, as suggested by the US Preventive Services Task Force 2 and supported by other studies 3, 4, 5, 6.
• This age recommendation is based on the increasing disease burden among individuals under age 50, emerging data on the prevalence of advanced colorectal neoplasia, and modeling studies that demonstrate the benefits of screening outweigh the potential harms and costs 5.
• It is essential to note that screening guidelines may vary depending on individual risk factors, and some guidelines recommend screening at different ages for high-risk individuals 4.

Screening Modalities

• Several screening modalities are recommended, including colonoscopy, fecal immunochemical test (FIT), computed tomographic colonography (CTC), and others 2, 3, 4, 6.
• The choice of screening modality should be based on individual preferences, test performance, screening interval, accessibility, and cost 2.

Importance of Screening

• Regular screening for colon cancer can reduce mortality and is a crucial step in preventing the disease 2, 3, 6.
• Increasing public awareness of the importance of screening and implementing mass national screening programs can detect early colon cancer and decrease related mortality 3.