Colorectal Cancer Screening Age Range
For average-risk individuals, begin colorectal cancer screening at age 45 and continue through age 75, with selective screening between ages 76-85 based on prior screening history and health status, and no screening after age 85. 1
Starting Age: 45 Years
The U.S. Multi-Society Task Force and USPSTF recommend initiating screening at age 45 for all average-risk individuals, though this carries a weaker recommendation (Grade B) compared to the strong recommendation for starting at age 50 (Grade A). 1
The rationale for lowering the starting age to 45 is based on rising colorectal cancer incidence in younger adults, with rates in 45-49 year-olds now similar to those previously seen in 50-59 year-olds, and similar prevalence of advanced neoplasia between these age groups. 1, 2
If you must prioritize resources, age 50 remains the strongest evidence-based starting point (strong recommendation, high-quality evidence), while age 45-49 screening is supported by lower-quality evidence. 1, 2
Stopping Age: A Tiered Approach
Age 75: Routine Screening Stops
For individuals who are up-to-date with screening and have negative prior tests (particularly a negative colonoscopy), stop routine screening at age 75. 1, 2
The 10-year lag time between screening and mortality benefit means that at age 75, with average life expectancy of 9.9 years for men and 12 years for women, the benefits diminish substantially. 1
Ages 76-85: Selective Screening Only
Screen only individuals aged 76-85 who have never been screened previously, considering their overall health status, comorbidities, and life expectancy. 1, 2
The USPSTF gives this a Grade C recommendation, indicating the net benefit is small and should be selectively offered. 1
Do not screen individuals in this age range who have had prior negative screening, as harms outweigh benefits. 1, 3
Age 86 and Older: No Screening
Individuals age 86 and older should not be offered colorectal cancer screening under any circumstances. 1, 2
At this age, overall mortality risk and adverse events from colonoscopy definitively outweigh any potential life expectancy benefits. 1
Special Populations Requiring Earlier Screening
Family History of Colorectal Cancer
Begin screening at age 40 OR 10 years before the age of diagnosis of the youngest affected first-degree relative, whichever comes first. 2, 4
This applies to individuals with a first-degree relative diagnosed with colorectal cancer or advanced adenoma before age 60, or two first-degree relatives diagnosed at any age. 4
Use colonoscopy every 5 years (not 10 years) for these higher-risk individuals. 4
Life Expectancy Less Than 10 Years
Stop screening at any age if life expectancy is less than 10 years due to comorbidities, regardless of prior screening history. 1, 2, 3
For patients with severe comorbidities, consider stopping as early as age 66. 3
Critical Pitfalls to Avoid
Do not delay diagnostic evaluation in symptomatic individuals of any age, particularly those with rectal bleeding, even if they are younger than screening age or older than stopping age. 2
Do not continue screening beyond age 85 even in healthy individuals, as evidence clearly shows harms outweigh benefits. 1, 2
Do not apply average-risk screening intervals to individuals with prior advanced adenomas or polyps—these patients require surveillance colonoscopy at shorter intervals determined by their findings. 3
Do not screen individuals with life expectancy under 10 years, as they will not live long enough to benefit from the 10.3-year average time to prevent one colorectal cancer death. 1