Colorectal cancer screenings should start at 45, say guidelines

Colorectal cancer is a leading cause of cancer deaths in the United States. Each year, more than 150,000 people are diagnosed and more than 52,000 people die of the disease, according to the American Cancer Society (ACS).

One of the best ways to help prevent colorectal cancer is getting screened. Screenings look for signs of illness in people who have no symptoms. They help protect you from many diseases—and may even save your life. In terms of colorectal cancer, they can find early potential clues of the illness, often before they progress into cancer. Receiving treatment early increases your chances of a positive outcome.

Both colorectal cancer screening guidelines and methods have changed in recent years. Here’s what to know about them, so you can safeguard your health.

When should you be screened?

Experts recommend the following age guidelines for colorectal cancer screening:

• Regular screenings should continue from age 45 through 75, as long as a person is in good health and has a life expectancy of more than 10 years.
• Adults between 76 and 85 years old should make an informed decision with their healthcare provider (HCP) about whether to continue screenings based on life expectancy, current health, prior screening results, and personal preference.
• Colorectal cancer screenings are not recommended over the age of 85.

In 2021, the U.S. Preventive Services Task Force (USPSTF) updated its guidelines for colorectal cancer screening. The group recommended that adults at average risk begin screening at age 45 instead of age 50, which they had previously advised. The guidance followed a similar recommendation made by the ACS in 2018.

The update was largely due to an increased rate of colorectal cancer among younger people. While the overall colorectal cancer death rate is dropping, it’s rising for adults under age 55. In 1995, people ages 54 or younger accounted for about 1 in 9 cases, according to the ACS. By 2019, they accounted for 1 in 5 cases.

The reasons for this rise are not clear. Some research suggests that unhealthy diets—especially those high in processed meat and fat and low in fruits and vegetables—may be contributing. Increasing rates of obesity, sedentary lifestyles, smoking, and alcohol use may also be factors.

Some people at higher risk for colorectal cancer should also discuss earlier screening with HCP, regardless of their age. These risk factors include:

• Family and personal history of colorectal cancer or polyps
• Personal history of inflammatory bowel disease
• Family history of rare inherited syndromes linked to colon cancer
• Experience with radiation to the abdomen to treat a previous cancer

People of African American, Ashkenazi Jewish, Native American, or Native Alaskan decent have a higher colorectal cancer risk, as well.

What are the recommended screening options?

There are a few main kinds of screening tests for colorectal cancer. The type of screening you choose should be based on personal preference and availability. Whichever you pick, if it comes back positive or abnormal, it should be followed up by a colonoscopy as soon as possible.

Visual exams

The gold standard of screening for colorectal cancer is a colonoscopy. Getting one every 10 years remains the option preferred by many experts.

Colonoscopies are performed by doctors. The day before, you’ll be given special instructions to clear out your bowels. This often involves following a clear-liquid diet and taking laxatives. During the procedure, a doctor will use a flexible metal tube to examine the lining of your colon (large intestine) and rectum (end of your digestive system). The tube has a camera on the end to help identify polyps (growths) or other potentially cancerous areas, which the doctor can cut away to be examined. You’ll receive anesthesia and likely be finished under an hour.

Other visual screening options are recommended every five years. These include:

• CT (virtual) colonoscopy, which takes X-rays and CT scans of the area
• Flexible sigmoidoscopy, which uses a camera to examine the last third of the colon, plus the rectum

Stool tests

Stool tests involve sending a sample of your stool (poop) to a lab for examination. There are three primary kinds used for colorectal cancer screening:

• Highly sensitive fecal immunochemical test (FIT)
• Highly sensitive guaiac-based fecal occult blood test (gFOBT)
• Multi-targeted stool DNA test with fecal immunochemical testing (FIT-DNA)

The FIT and gFOBT tests should be performed every year. It’s recommended the FIT-DNA test is done every three years.

Blood tests

There are two blood tests approved by the U.S. Food & Drug Administration for colorectal cancer screening. These are not yet recommended by many health experts, however. That’s because they are more likely to find cancer at a later stage, when it’s more difficult to treat. They also have a false positive rate of about 10 percent. That means 10 percent of the time, they show signs of colorectal cancer when none are present. Anyone with a positive blood test—including false positives—would still need to undergo a follow up colonoscopy to confirm their result.

Importance of colorectal cancer screening

A 2025 study from the Centers for Disease Control and Prevention (CDC) found that about one-third of participants ages 45 to 75 had never been screened for colorectal cancer. Within that group, about two-thirds of people ages 45 to 49 hadn’t received screenings.

Screenings save lives. If a person is diagnosed with colorectal cancer early, when it hasn’t spread, they have about a 9 in 10 chance of living at least five years, according to the ACS. If they’re diagnosed after it spreads to distant parts of the body, their chances of survival drop to under 2 in 10.

If you’re at high risk or are age 45 or older and at average risk for colorectal cancer, discuss screening with your HCP. They can answer questions and help you decide on screening approach that’s right for you.