From the Guidelines
A healthy 38-year-old woman should begin colon cancer screening at age 45, as recommended by the most recent guidelines from the National Comprehensive Cancer Network (NCCN) in 2024 1. This recommendation applies to individuals at average risk for colorectal cancer with no family history of the disease, no personal history of inflammatory bowel disease, and no genetic syndromes associated with increased colorectal cancer risk. The screening can be done through various methods, including:
- Colonoscopy every 10 years
- Stool-based tests (like FIT tests annually or multi-target stool DNA tests every 3 years)
- Visual exams like flexible sigmoidoscopy every 5 years
However, if she has a family history of colorectal cancer or advanced polyps, especially in first-degree relatives diagnosed before age 60, screening should begin earlier—typically at age 40 or 10 years before the youngest diagnosed relative, whichever comes first, as suggested by the US Multi-Society Task Force in 2017 1. This earlier screening timeline is recommended because colorectal cancer rates have been increasing in younger adults, and early detection significantly improves treatment outcomes by finding polyps before they develop into cancer or detecting cancer at more treatable stages. The American Cancer Society, US Preventive Services Task Force, and American College of Gastroenterology also support starting screening at age 45 for average-risk individuals, with some variations in recommendations for those with a family history of colorectal cancer 1.
From the Research
Colorectal Cancer Screening Guidelines
The American Cancer Society recommends initiating screening for all average-risk adults at 45 years old 2.
Risk Factors for Colorectal Cancer
Family history of colorectal cancer, other cancers, and advanced colon polyps are strong risk factors that must be considered in order to implement earlier testing 2, 3, 4.
Screening Age Based on Risk Profile
For individuals with a high-risk profile, such as those with a family history of colorectal cancer or advanced adenoma, screening may be recommended at a younger age, such as 40-50 years or 10 years younger than the age of diagnosis of the first-degree relative 3. Some studies suggest that individuals with a high-risk profile may start screening up to 6-7 years earlier than the recommended age of 45 years, while those with a low-risk profile may start screening later 5.
Specific Recommendations for a 38-Year-Old Woman
- If the woman has no family history of colorectal cancer and is considered average-risk, screening would typically start at 45 years old 2.
- If the woman has a family history of colorectal cancer or other risk factors, screening may be recommended at a younger age, such as 40 years old or earlier, depending on the specific risk factors and family history 3, 4, 5. Some studies suggest that individuals with a risk score of 6-8 may start screening at age 38 years 5.
Key Points to Consider
- Family history and other risk factors play a significant role in determining the recommended screening age for colorectal cancer.
- Individuals with a high-risk profile may benefit from earlier screening, while those with a low-risk profile may be able to start screening later.
- The American Cancer Society recommends initiating screening for all average-risk adults at 45 years old, but this may vary depending on individual risk factors.