At what age should I start getting a colonoscopy?

Colorectal Cancer Screening Age Guidelines

For average-risk individuals, colorectal cancer screening should begin at age 45, as recommended by the most recent guidelines from the U.S. Multi-Society Task Force on Colorectal Cancer. 1

Screening Recommendations by Risk Category

Average-Risk Individuals

• Begin screening at age 45 1
• Strong recommendation for screening by age 50 if not started earlier 1
• Preferred screening options:
  • Colonoscopy every 10 years
  • Annual fecal immunochemical test (FIT)

High-Risk Individuals

• Family history of colorectal cancer or advanced adenomas:

  • First-degree relative diagnosed before age 60: Begin screening at age 40 or 10 years before the youngest affected relative's diagnosis, whichever comes first 1, 2
  • First-degree relative diagnosed at age 60 or older: Begin screening at age 40 1, 2
  • Two or more first-degree relatives with colorectal cancer at any age: Begin screening at age 40 or 10 years before the earliest diagnosis, whichever comes first 1
  • Recommended screening interval: Every 5 years 1, 2

• Genetic syndromes:

  • Familial adenomatous polyposis: Begin annual flexible sigmoidoscopy at age 10-12 1
  • Hereditary non-polyposis colorectal cancer (Lynch syndrome): Begin colonoscopy at age 20-25 or 10 years before the earliest case in the family, whichever comes first 1

Evidence Supporting Earlier Screening Age

Recent evidence shows that colorectal neoplasia rates in 45-49 year-olds approach those observed in 50-59 year-olds:

• Advanced colorectal neoplasia rates: 3.6% in 45-49 year-olds vs. 4.2% in 50-59 year-olds 1
• Among 45-49 year-olds, 17.5% had any colorectal neoplasia and 3.7% had advanced colorectal neoplasia 1
• Data from a large national registry showed that among patients aged 45-49,32% had any neoplasia and 7.5% had advanced premalignant lesions 3

When to Stop Screening

• Consider stopping screening at age 75 for individuals who are up-to-date with prior negative screening tests 1
• For individuals without prior screening, consider screening up to age 85, depending on overall health and comorbidities 1
• Life expectancy less than 10 years is a reasonable threshold to discontinue screening 1

Screening Compliance Challenges

Despite recommendations, screening rates among high-risk individuals remain suboptimal:

• Only 38.3% of first-degree relatives aged 40-49 with a family history of colorectal cancer had undergone colonoscopy screening 4
• Having health insurance triples the likelihood of receiving appropriate screening 4

Key Considerations for Clinicians

• Family history assessment is critical for determining appropriate screening age and interval
• The relative risk of colorectal cancer is approximately 2.4 when a first-degree relative is affected, and higher (3.8) when the relative is diagnosed before age 45 2
• Special efforts should be made to ensure screening takes place for individuals with a first-degree relative diagnosed with colorectal cancer before age 60 2
• The incidence of colorectal cancer in individuals with an affected first-degree relative parallels the risk in those with no family history but precedes it by about 10 years 1

Colorectal cancer incidence has been rising among younger Americans, making adherence to these age-appropriate screening guidelines increasingly important for early detection and prevention.