Colorectal Cancer Screening Now Starts at 45. Here Are Your Options.
Colonoscopy isn’t the only choice. A guide to the screening tests, how often you need them, and what happens after an abnormal result.
Key takeaways
- The U.S. Preventive Services Task Force recommends screening for adults 45 to 75 at average risk.
- Options include colonoscopy every 10 years, a yearly stool FIT test, or a stool DNA-FIT test every one to three years.
- Any abnormal stool-based or imaging test needs a follow-up colonoscopy to complete screening.
- People with a family history or symptoms may need earlier or different testing.
Colorectal cancer is one of the most preventable cancers, because screening can find precancerous polyps before they turn into cancer. In 2021, the U.S. Preventive Services Task Force lowered the recommended starting age from 50 to 45, reflecting rising rates of colorectal cancer in younger adults.
Who should be screened
The Task Force recommends screening for all adults aged 50 to 75 and for adults 45 to 49. For people aged 76 to 85, the decision should be individualized based on overall health and past screening. These recommendations apply to people at average risk without symptoms.
Your options
| Test | How often | What to know |
|---|---|---|
| Colonoscopy | Every 10 years | Requires bowel prep and sedation; polyps can be removed during the same procedure. |
| FIT (fecal immunochemical test) | Every year | At-home stool test for hidden blood; no prep. Works only if repeated yearly. |
| Stool DNA-FIT (such as Cologuard) | Every 1–3 years | At-home test combining DNA markers and blood detection; more false positives than FIT. |
| CT colonography | Every 5 years | Imaging test; requires bowel prep but no sedation. |
| Flexible sigmoidoscopy | Every 5 years (or every 10 with yearly FIT) | Examines only the lower part of the colon. |
The best test is the one you’ll actually complete. Stool tests are convenient, but they only work when done on schedule.
After an abnormal result
If a stool test or CT colonography is abnormal, a follow-up colonoscopy is needed to complete screening. Skipping it leaves the most important step undone.
When to screen earlier or differently
These guidelines are for average-risk adults. Talk to your clinician about earlier or more frequent screening if you have a parent, sibling or child with colorectal cancer or advanced polyps, inflammatory bowel disease, or a known hereditary syndrome such as Lynch syndrome.
Don’t wait for a screening date if you have symptoms such as rectal bleeding, a change in bowel habits, unexplained weight loss or iron-deficiency anemia. Those call for prompt evaluation at any age.
Frequently asked questions
At what age should you get a colonoscopy?
For people at average risk, the U.S. Preventive Services Task Force recommends colorectal cancer screening starting at age 45. Colonoscopy is one of several approved options.
Is Cologuard as good as a colonoscopy?
Stool DNA tests are a recommended screening option, but they are less accurate at finding precancerous polyps and produce more false positives. An abnormal result requires a colonoscopy.
How often do you need a FIT test?
FIT is done every year to be effective as a screening strategy.