Colorectal Cancer Screening Age Recommendations

Colorectal cancer screening should begin at age 45 for average-risk individuals, with stronger evidence supporting initiation at age 50. 1

Starting Age for Screening

For average-risk individuals ages 45-49, screening is suggested but with a weak recommendation based on low-quality evidence 1
For average-risk individuals age 50 and older, screening is strongly recommended based on high-quality evidence 1
The recommendation to begin screening at age 45 is based on:
- Increasing CRC incidence in younger adults 1
- Similar incidence rates in 45-49 year-olds now compared to 50-year-olds when screening was first recommended 1
- Similar rates of advanced neoplasia in 45-49 year-olds compared to screening cohorts of 50-59 year-olds 1

Individuals with a family history of CRC in a first-degree relative should begin screening at age 40 or 10 years before the age of diagnosis of the youngest affected relative, whichever comes first 1
For those with Lynch Syndrome, colonoscopy should begin 10 years before the age at diagnosis of the youngest affected relative 1
Individuals with Family Colon Cancer Syndrome X should undergo colonoscopy every 5 years beginning 10 years before the age at diagnosis of the youngest affected relative or age 40, whichever is earlier 1

First-tier options (strongly recommended):
- High-quality colonoscopy every 10 years 1
- Annual fecal immunochemical test (FIT) 1
Second-tier options for those who decline first-tier tests:
- Flexible sigmoidoscopy every 5-10 years 1
- CT colonography every 5 years 1
- FIT-fecal DNA every 3 years 1
Capsule colonoscopy every 5 years is suggested only when all other options are declined 1

Consider stopping screening at age 75 for individuals who are up to date with screening and have negative prior screening tests, particularly high-quality colonoscopy 1, 2
For individuals aged 76-85 without prior screening, decisions should be individualized based on overall health status and life expectancy 1
Screening should not be offered to individuals over age 85 1, 2

African Americans have higher CRC incidence rates and may particularly benefit from starting screening at age 45 2
Individuals with symptoms (particularly bleeding symptoms) should undergo diagnostic evaluation regardless of age 1
The prevalence of colorectal neoplasia is significantly lower in those aged 40-49 (12.1%) compared to those aged 50-59 (22.6%), supporting the current age recommendations 3

Delaying evaluation of symptomatic individuals regardless of age, especially those with bleeding symptoms 1
Continuing screening beyond age 85 when evidence shows harms outweigh benefits 1, 2
Not considering family history when determining screening initiation age 1
Not following up on positive results from non-colonoscopy screening tests with timely colonoscopy 1