When Should You Start Getting Screened for Colorectal Cancer?

Written By:ACS Medical Content and News Staff

Colorectal cancer is the second most common cause of cancer death in the United States when men and women are combined. However, regular screening can find colorectal cancer when it is small, hasn’t spread, and might be easier to treat. Some types of screening can also help find and remove pre-cancerous growths called polyps before they have a chance to turn into cancer. 

The American Cancer Society (ACS) has guidelines for colorectal cancer screening and recommends people at average risk for colorectal cancer begin screening at age 45. In the most recent guideline update, ACS lowered the age to start screening because studies show rates of colorectal cancer among people younger than 50 are on the rise. ACS experts have determined that screening starting at 45 could help save more lives.

Screening recommendations for those at average risk for colorectal cancer

  • People at average risk should start regular screening at age 45.
  • People who are in good health and expected to live at least more 10 years should continue regular screening through the age of 75.
  • People ages 76 through 85 should decide with their health care provider whether to continue to get screened. This should be based on personal preferences, prior screening results, overall health and how long they are expected to live. 
  • People over 85 should no longer get screened for colorectal cancer.

Screening for people at higher risk for colorectal cancer

People at higher risk for colorectal cancer may need to start screening before age 45. They may also need to be screened more often or get specific tests. People at higher risk are those with

  • A strong family history of colorectal cancer or certain types of polyps
  • A personal history of colorectal cancer or certain types of polyps
  • A personal history of inflammatory bowel disease (ulcerative colitis or Crohn’s disease)
  • A family history of a hereditary syndrome such as familial adenomatous polyposis (FAP) or Lynch syndrome 
  • A history of radiation to the abdomen (belly) or pelvis to treat a prior cancer

People who think or know they are at higher risk for colorectal cancer should talk to their health care provider. Your health care provider can help you choose your best screening option and schedule.

If you’ve delayed your screening appointments or they have been postponed due to the COVID-19 pandemic, talk to your doctor about the steps you can take to safely resume these important tests.

Recommended colorectal cancer screening tests

There are several test options for colorectal cancer screening. There are some differences among the tests. But the most important thing is to get screened, no matter which test you choose. 

Stool-based tests:

  • Highly sensitive fecal immunochemical test (FIT) every year
  • Highly sensitive guaiac-based fecal occult blood test (gFOBT) every year
  • Multi-targeted stool DNA test (MT-sDNA) every 3 years

Visual exams:

  • Colonoscopy every 10 years
  • CT colonography (virtual colonoscopy) every 5 years
  • Flexible sigmoidoscopy (FSIG) every 5 years

It’s important that everyone talk to their health care provider about which tests might be good options. You should also check your insurance about payment for each test option.

These screening tests must be done at recommended time points to be effective. If you choose a test other than a colonoscopy, any abnormal test result must be followed up with a colonoscopy to see whether you have cancer.

How to find more information

  • The best way to know when to begin colorectal cancer screening and how often to get screened is to talk to your health care provider.
  • Learn more about colorectal cancer screening by calling the American Cancer Society at 1-800-227-2345 or visiting us at cancer.org/coloncancer.
  • Click on the “Helpful Resources” section below to find links to more information on cancer.org.

The American Cancer Society medical and editorial content team

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Colorectal Cancer Screening for Average-Risk Adults: 2018 Guideline Update from the American Cancer Society. Published May 30, 2018 in CA: A Cancer Journal for Clinicians. First author Andrew M.D. Wolf, MD. University of Virginia School of Medicine, Charlottesville, Va.

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