From the Guidelines
Colonoscopy screening should begin at age 45 for average-risk individuals and continue until age 75, as recommended by the most recent and highest quality studies, including the US Preventive Services Task Force 1 and the American College of Gastroenterology 1.
Key Considerations
- The decision to start screening at age 45 is based on the increasing risk of colorectal cancer after this age and the benefits of early detection in improving treatment outcomes and survival rates.
- For those with a family history of colorectal cancer, screening may need to start earlier, at age 40 or 10 years before the youngest case in the family, as recommended by the US Multi-Society Task Force 1.
- African Americans may also benefit from starting screening at age 45 due to their higher risk of colorectal cancer.
Screening Recommendations
- Average-risk individuals: start screening at age 45 and continue until age 75.
- Individuals with a family history of colorectal cancer: start screening at age 40 or 10 years before the youngest case in the family.
- African Americans: start screening at age 45.
Follow-up Colonoscopies
- The timing of follow-up colonoscopies depends on the findings during the initial screening, ranging from 1 year for high-risk polyps to 10 years for normal results.
- The decision to continue screening after age 75 should be individualized based on overall health, life expectancy, and screening history.
- For those over 85, screening is generally not recommended, as stated by the American College of Physicians 1 and the US Preventive Services Task Force 1.
From the Research
Colonoscopy Screening Age
- The U.S. Multi-Society Task Force on Colorectal Cancer recommends average-risk CRC screening to begin at age 45, based on increasing disease burden among individuals under age 50 and emerging data on the prevalence of advanced colorectal neoplasia 2.
- A study using the CRC-SPIN microsimulation model found that decennial colonoscopy screening initiation at age 45 remained a robust recommendation, yielding more life-years gained while requiring the least number of colonoscopies across different model assumptions 3.
- Research on colonoscopic screening in average-risk individuals ages 40 to 49 vs 50 to 59 years found that the prevalence of adenomas was similar in both age groups, although the prevalence of advanced neoplasia may be higher in the 50-59 years age group 4.
- The decision to start or continue screening for individuals ages 76 to 85 should be individualized and based on prior screening history, life expectancy, CRC risk, and personal preference, with screening not recommended after age 85 2.
- Other factors, such as polyp size, can also impact the long-term risk of colorectal cancer in a screening population, with age at screening being the main predictive factor for colorectal cancer 5.