Start Colon Cancer Screening at 45, Not 50, American Cancer Society Urges

When Should I Get Screened for Colorectal Cancer?

Colorectal cancer is cancer that develops in the colon or rectum. It often begins as a growth called a polyp on the inner lining of the colon or rectum. Some types of polyps can become cancerous over time.

The good news is that colorectal cancer is one of the cancers that screening can help prevent. During a colonoscopy, a gastroenterologist can identify and remove certain precancerous polyps before they have the opportunity to develop into cancer. Screening can also find colorectal cancer at an earlier stage, when treatment is generally more successful.

So, when should you get screened for colorectal cancer?

For adults at average risk, current guidelines recommend starting regular colorectal cancer screening at age 45. But your personal screening schedule may be different if you have a family history of colorectal cancer, a personal history of polyps, inflammatory bowel disease, or another risk factor.

When Should You Start Colorectal Cancer Screening?

The American Cancer Society (ACS) and U.S. Preventive Services Task Force (USPSTF) recommend that adults at average risk begin colorectal cancer screening at age 45. The USPSTF recommends screening adults ages 45 through 75, while the ACS 2026 guideline recommends continuing screening through age 75 for people in good health with a life expectancy of more than 10 years.

For adults ages 76 through 85, screening is no longer automatically recommended for everyone. The decision should be individualized based on factors such as overall health, life expectancy, previous screening history, and personal preferences. The ACS recommends that adults older than 85 stop colorectal cancer screening.

These recommendations apply to adults who are asymptomatic and at average risk. If you have symptoms that could indicate colorectal cancer, you should talk with your healthcare provider regardless of your age.

Should I Be Screened for Colorectal Cancer Before Age 45?

Colorectal cancer is more common as people get older, but it can occur in younger adults as well. People with certain risk factors may need to begin screening before age 45 or may need more frequent screening.

Risk factors can include:

A strong family history of colorectal cancer or certain types of polyps
A personal history of colorectal cancer or certain types of polyps
Inflammatory bowel disease, including Crohn’s disease or ulcerative colitis
A hereditary colorectal cancer syndrome, such as Lynch syndrome or familial adenomatous polyposis (FAP)
Certain other inherited genetic conditions
A history of radiation therapy involving the abdomen or pelvis

Having a first-degree relative—such as a parent, sibling, or child—with colorectal cancer can be particularly important when determining when screening should begin.

If you have an increased risk for colorectal cancer, don’t simply follow the standard age-45 recommendation. Talk with a gastroenterologist about a personalized colorectal cancer screening plan.

What Are the Colorectal Cancer Screening Options?

There is more than one recommended way to screen for colorectal cancer.

The USPSTF recommends several screening strategies for adults at average risk, including:

Colonoscopy every 10 years
FIT (fecal immunochemical test) every year
Stool DNA-FIT every 1 to 3 years
CT colonography every 5 years
Flexible sigmoidoscopy every 5 years
Flexible sigmoidoscopy every 10 years combined with annual FIT

The 2026 ACS guideline also recognizes stool-based tests and visual examinations—most commonly colonoscopy—as preferred screening approaches. The ACS emphasizes that having multiple screening options can help more people complete screening.

The best screening test is ultimately the one that is appropriate for your risk level and that you will actually complete.

How Does a Colonoscopy Help Prevent Colorectal Cancer?

Colonoscopy is an important colorectal cancer screening option because it allows our gastroenterologists to examine the entire colon and rectum for polyps, abnormal tissue, or cancer.

One of its biggest advantages is that polyps can often be removed during the same procedure. Removing certain precancerous polyps can prevent them from developing into colorectal cancer.

If you choose a stool-based screening test or another non-colonoscopy screening method and receive a positive result, a timely follow-up colonoscopy is recommended to complete the evaluation.

How Long Does a Colonoscopy Take?

The colonoscopy itself is generally a relatively short procedure, although the total time at the endoscopy center will be longer because of preparation, sedation, recovery, and discharge.

Before the procedure, you’ll need to follow bowel-preparation instructions to clean the colon. An adequately prepared colon is important because leftover stool can make it more difficult to see polyps and other abnormalities.

Your gastroenterology team at Digestive Healthcare Center will provide specific preparation instructions based on your health history and the type of preparation prescribed.

What Makes a High-Quality Colonoscopy?

Not all colonoscopies are identical. The quality of the examination matters.

The American Society for Gastrointestinal Endoscopy (ASGE) and American College of Gastroenterology (ACG) updated their colonoscopy quality indicators in 2024. The updated recommendations emphasize several measures that help assess the quality and effectiveness of colonoscopy.

Adenoma Detection Rate

One of the most important measures is the adenoma detection rate (ADR)—the percentage of eligible patients undergoing colonoscopy in whom at least one conventional adenoma is detected and confirmed by pathology.

Under the updated 2024 ASGE/ACG quality indicators, the minimum acceptable ADR threshold is 35% for the defined population of patients age 45 and older undergoing screening, surveillance, or diagnostic colonoscopy, excluding certain populations such as those undergoing colonoscopy after a positive non-colonoscopy screening test. The sex-specific thresholds are 40% for men and 30% for women.

ADR is important because detecting and removing precancerous adenomas is central to the cancer-prevention benefit of colonoscopy.

Sessile Serrated Lesion Detection

The updated quality standards also recognize the sessile serrated lesion detection rate (SSLDR) as an important quality measure. The recommended minimum threshold is 6%. Sessile serrated lesions are another type of precancerous colorectal lesion that can contribute to colorectal cancer development.

Adequate Bowel Preparation

The quality of the bowel preparation matters, too. The updated ASGE/ACG recommendations call for an adequate bowel-preparation rate of at least 90% in outpatient colonoscopy.

A clean colon allows the gastroenterologist to thoroughly examine the lining and improves the likelihood of detecting important lesions.

Complete Examination of the Colon

Another quality indicator is the cecal intubation rate, which measures how often the colonoscope successfully reaches the cecum, allowing the entire colon to be examined. The updated ASGE/ACG target is at least 95%.

These quality measures are important because the effectiveness of colonoscopy depends not simply on having the procedure, but on performing a thorough, high-quality examination.

How Safe Is Colonoscopy?

Colonoscopy is generally safe, but like any medical procedure, it carries potential risks.

Possible complications include bleeding, perforation of the colon, and complications related to sedation. Serious complications are uncommon, but the risk can vary depending on factors such as age, whether polyps are removed, and a person’s overall health.

In the evidence reviewed by the USPSTF, serious adverse events among screening populations were estimated at approximately 3.1 perforations and 14.6 major bleeding events per 10,000 colonoscopies.

Current ASGE/ACG quality guidance emphasizes that serious adverse events—including perforation, delayed bleeding, and death—should be tracked, documented, and reviewed as part of a practice’s quality-improvement process.

For patients, this means it’s reasonable to ask about the quality and safety practices of the endoscopy center and gastroenterologist performing your procedure.

What Are the Symptoms of Colorectal Cancer?

Polyps and colorectal cancer don’t always cause symptoms, particularly in the early stages. That’s one reason screening is so important.

When symptoms do occur, they may include:

A persistent change in bowel habits, including diarrhea or constipation
Rectal bleeding
Blood in the stool
Abdominal pain, cramping, or discomfort
Unexplained weight loss
Weakness or fatigue
A feeling that the bowel does not completely empty

These symptoms can have many causes other than colorectal cancer. Hemorrhoids, infections, inflammatory bowel disease, and other digestive conditions can produce similar symptoms.

However, persistent or concerning symptoms should not be ignored. Screening recommendations are designed for people without symptoms. If you’re experiencing symptoms that could indicate colorectal cancer, your doctor may recommend diagnostic evaluation regardless of your age.

Why Is Colorectal Cancer Screening So Important?

Colorectal cancer screening can find cancer earlier and, in the case of certain polyps, can help prevent cancer from developing.

That’s why you shouldn’t wait until you have symptoms to start thinking about screening.

For average-risk adults, screening should begin at age 45. If you have a family history or another risk factor, your screening may need to begin sooner.

Lifestyle choices can also contribute to colorectal cancer prevention. These include:

Maintaining a healthy weight
Exercising regularly
Eating a diet rich in vegetables, fruits, whole grains, and other plant foods
Limiting red meat and avoiding or minimizing processed meat
Avoiding tobacco
Limiting or avoiding alcohol

These measures can support overall health, but lifestyle choices do not replace recommended colorectal cancer screening.

What Happens If Another Screening Test Is Positive?

A stool-based test or other non-colonoscopy screening test can be a convenient way to screen for colorectal cancer.

However, an abnormal result requires follow-up.

For example, if a FIT or stool DNA-FIT test comes back positive, a follow-up colonoscopy is needed to determine why the test was abnormal and to look for polyps or cancer. The ACS 2026 guideline specifically emphasizes timely colonoscopy after a positive non-colonoscopy screening test.

This is important when choosing a screening method: stool tests can be effective screening tools, but they do not provide the same opportunity to directly examine the colon and remove a polyp during the screening test.

Colorectal Cancer Screening in New Jersey at DHC

At Digestive Healthcare Center, our experienced gastroenterologists help patients throughout Hillsborough, Somerville, Warren, and surrounding New Jersey communities understand their colorectal cancer risk and stay current with appropriate screening.

Our Colon Cancer Prevention Program is designed to help patients take a proactive approach to colorectal cancer prevention and early detection.

Whether you’re approaching age 45, have a family history of colorectal cancer, have questions about your screening options, or have received an abnormal screening result, our gastroenterology team can help you determine the appropriate next step.

Don’t wait for symptoms to take action. Contact Digestive Healthcare Center today to discuss your colorectal cancer screening options.

Make an Appointment for Comprehensive Digestive Care in NJ

At Digestive Healthcare Center, we want every patient at our New Jersey offices to feel confident about their digestive health. We encourage you to contact us today to make an appointment with one of our experienced gastroenterologists.

Your age, risk factors, screening history, and personal preferences all matter when determining the right colorectal cancer screening plan. Let our team help you take the next step in prevention.

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