From the Guidelines
Colonoscopy screening is generally recommended to begin at age 45 for people at average risk of colorectal cancer. This recommendation is based on the most recent and highest quality study, which suggests that the incidence of colorectal cancer in individuals aged 45-49 is similar to that of individuals aged 50-59, and that screening at age 45 can help prevent colorectal cancer and reduce mortality 1.
The decision to initiate or continue screening after age 75 should involve a shared decision-making process between a patient and provider that considers prior screening history, life expectancy, CRC risk, and patient preferences. Individuals ages 86 and older should not be offered CRC screening, as the overall mortality risk and risk of adverse events associated with colonoscopy outweigh the life expectancy benefits 1.
For those with higher risk factors, such as a family history of colorectal cancer, personal history of inflammatory bowel disease, certain genetic syndromes, or previous polyps, screening may be recommended at a younger age, sometimes as early as age 40 or even earlier, and may need to be performed more frequently 1.
Some key points to consider when recommending colonoscopy screening include:
- The colonoscopy procedure allows doctors to examine the entire colon and rectum for polyps or cancerous growths, and remove precancerous polyps during the same procedure.
- The recommendation for earlier screening reflects the understanding that colorectal cancer develops slowly over time, and detecting and removing precancerous polyps can prevent cancer from developing.
- The American Cancer Society recommends that adults aged 45 years and older with an average risk of CRC undergo regular screening with either a high-sensitivity stool-based test or a structural (visual) examination, depending on patient preference and test availability 1.
Overall, the recommendation to start colonoscopy screening at age 45 is based on the latest evidence and aims to reduce morbidity, mortality, and improve quality of life for individuals at average risk of colorectal cancer.
From the Research
Recommended Age for Colonoscopy
The recommended age for a colonoscopy, also known as a colon examination, is a topic of discussion among medical professionals.
- According to the U.S. Multi-Society Task Force on Colorectal Cancer, average-risk individuals should start colorectal cancer screening at age 45 2.
- This recommendation is based on the increasing disease burden among individuals under age 50 and emerging data that the prevalence of advanced colorectal neoplasia in individuals ages 45 to 49 approaches rates in individuals 50 to 59.
- A systematic review of colorectal cancer screening guidelines for average-risk and high-risk individuals found that most guidelines recommend screening between 45 and 75 years for average-risk individuals 3.
- For high-risk individuals, such as those with a positive family history of colorectal cancer, screening should begin at age 40 3, 4.
Screening Intervals and Modalities
- The recommended screening intervals and modalities vary depending on the individual's risk level and personal preference.
- Colonoscopy is a frequently suggested screening modality, with recommended intervals of every 10 years for average-risk individuals and every 5-10 years for high-risk individuals 3.
- Other screening modalities, such as fecal immunochemical test (FIT) and computed tomographic colonography (CTC), are also recommended, with varying intervals depending on the individual's risk level 3.
Importance of Early Screening
- Early screening is crucial for detecting colorectal cancer at an early stage, when it is more treatable.
- A study found that approximately 53% of enrollees initiated colorectal cancer screening within five years after turning 50, highlighting the need for improved screening rates 5.
- Another study discussed the importance of innovative health education campaigns aimed at younger patients to improve colon cancer screening rates, particularly among those aged 45-49 6.