Colorectal cancer screening guidelines: What you should know

A lot of people put off their recommended cancer screenings – especially colorectal cancer screenings like colonoscopies. In fact, according to the Centers for Disease Control and Prevention (CDC), about 25% of adults have not been screened as recommended.

For some, fear of colonoscopy prep and the test itself keep them from scheduling their screening. Others are healthy and don’t have any colorectal cancer symptoms, so they don’t think they need to be screened. But it’s important to know that colorectal cancers – cancers of the colon and rectum – are the second-leading cause of cancer-related deaths among men and women in the United States.

You want to be as healthy as possible for as long as possible. And you want that for your partner, parents and grandparents, as well as close friends and loved ones. That’s why we encourage you to get screened and tell those you love to get screened, too.

We know you might have questions about when screening for colorectal cancer should start, how often you should have them, if a colonoscopy is the only screening option, and more. To help you find out what you need to know, keep reading for some of the most common questions we get about colon cancer screening tests.

What is a colorectal (colon) cancer screening?

Colorectal cancer screenings, also called colon cancer screenings, are how we look for cancer or precancer in people who have no symptoms of the disease. This is important because many people with colon cancer or rectal cancer don’t experience symptoms in the early stages of the disease.

Why are colorectal cancer screenings important?

While colorectal cancer is second only to lung cancer in cancer-related deaths in the U.S., it’s also a cancer that can be prevented or detected at an early stage. That’s where screenings come in.

When found at an early stage (before it has spread), the five-year relative survival rate for colorectal cancers is about 90%, according to the American Cancer Society. But less than half of colorectal cancers are found at this early stage. That’s why screening tests such as colonoscopies and stool tests are recommended at specific times – they save lives.

What is the colorectal cancer screening age?

Many people wonder at what age they should you get screened for colorectal cancer. The latest guidance from the United States Preventive Services Task Force and the American Cancer Society recommends that colorectal cancer screenings begin at age 45 for both men and women. And for those with certain colon cancer risk factors – which we talk about in more detail below – doctors often recommend beginning screenings earlier.

This might be different from what you’ve heard in the past. That’s because the starting age for colorectal cancer screenings used to be 50, but the recommendation was updated in 2021 as colorectal cancer in younger people has increased.

How often is colorectal cancer screening recommended?

How often you should be screened for colon and rectal cancers largely depends on two factors: Your individual risk level and the type of screening test that is chosen.

For example, if you’re 45 or older, at average risk for developing colorectal cancer and opt for a stool test, you’ll submit a sample once a year until your doctor recommends otherwise. If you opt for a colonoscopy, every 10 years is typically recommended.

On the other hand, if you’re at a higher risk, then a colonoscopy is strongly recommended.

Your individual screening needs should be discussed with your doctor. It’s also important to remember that your screening recommendations can change throughout your life, based on previous test results, preferences and overall health.

There are a range of factors that can increase a person’s risk of developing colorectal cancer, including:

Family history

If you have a family history of rectal or colon cancer, your risk of getting the disease can be higher. So if you have a grandparent, parent, sibling or child who’s had the disease, tell your primary care doctor right away. This is especially true if you have more than one family member with the disease or if your family member was diagnosed before they were 50 years old.

Doctors often recommend starting screening at age 40 or 10 years before the age that an immediate family member was diagnosed with the disease, whichever comes first.

What if you don’t have a family history of colon cancer?

While family history can raise your risk level, most people diagnosed with colon cancer have no family history of the disease. That’s because your individual risk can be impacted by several factors – which is why it’s so important to follow colon cancer screening guidelines.

Personal history of colorectal cancer or precancer

The results of a previous colonoscopy can change your risk level and need for follow-up screenings. For example, if a precancerous polyp was found during a colonoscopy, you may be at greater risk of getting colorectal cancer. So, your doctor will likely recommend getting another colonoscopy within 3-5 years, rather than 10.

Also, for those who were diagnosed with colorectal cancer, more frequent screenings will likely be recommended in the future since they’re at an increased risk for a recurrence.

Previous radiation to your abdomen or pelvic area

If you’ve had radiation therapy on your abdomen or pelvic area to treat a prior cancer, colorectal cancer screenings may be recommended sooner than 45 – as early as 30 in some cases. Recommendations vary based on your previous diagnosis, your age and other risk factors. So you should talk with your doctor about what may be best for you.

Race

African American and Native American populations are at a higher risk for developing colorectal cancer than people of other races.

Genetics

While a relatively small percentage of colon cancers are connected to inherited genes, certain gene mutations that are passed down can significantly increase your risk of colorectal cancer. Among those hereditary colorectal cancer syndromes are familial adenomatous polyposis and Lynch syndrome (also known as hereditary non-polyposis colon cancer or HNPCC). Both genetic conditions can be identified with genetic testing.

Familial adenomatous polyposis

Familial adenomatous polyposis (FAP) is a rare, inherited polyp syndrome, accounting for an estimated 1% of all colorectal cancers. It can lead to hundreds or even thousands of polyp growths in a person’s colon or rectum. These growths can appear in children as young as 10 years old, and by age 20, cancer is usually present in at least one polyp.

Lynch syndrome

Lynch syndrome is the most common hereditary cause of colorectal cancers. This condition is responsible for between 2-4% of all colorectal cancers. Unlike FAP, colorectal cancers related to Lynch syndrome may have few or no polyps present.

Inflammatory bowel disease

Inflammatory bowel diseases like Crohn’s disease or ulceraive colitis cause cells in the intestinal lining to constantly turn over and be replaced by new ones, which can increase the chances of abnormal cells.

People with IBD often receive their first colorectal cancer screening eight years after their diagnosis or at age 45, whichever comes first. Screening frequency will depend on screening results and other risk factors but may be recommended every 1-3 years after the first screening.

Lifestyle factors

Certain behaviors and lifestyle factors can also increase you risk of colorectal cancer. These include:

  • Lack of regular physical activity
  • Poor diet with not enough colon-healthy foods
  • Being very overweight
  • Drinking alcohol
  • Using tobacco products

It’s possible that your doctor may recommend earlier screening if you have any of these risk factors. But they’ll also likely recommend taking steps to reduce these risks and improve your overall health.

When do you stop screening for colorectal cancer?

The decision of when to stop screening for rectal and colon cancers can depend on your health and your preferences. Screening recommendations are based on the possible benefits and risks associated with available screening tests.

Generally, regular colorectal cancer screenings are recommended until age 75. Between ages 76-85, you should talk with your doctor about the pros and cons of screenings, and make your decision based on your personal preferences and health. After 85, screenings aren’t recommended as the potential risks of screenings can outweigh the potential benefits.

Are colorectal cancer screenings covered by insurance?

Most cancer screening tests are 100% covered by insurance, even if you haven’t met your deductible. Since the recommended colorectal cancer screening age was recently lowered, make sure to check with your insurance provider about coverage changes.

Colorectal cancer screening options

The most common colorectal cancer screening tool is colonoscopy. Stool tests called fecal immunochemical tests – or FIT tests for short – are another popular screening option.

Colonoscopy

What is a colonoscopy test? A colonoscopy is a procedure that lets your doctor check the lining of your colon for anything unusual such as inflamed or swollen tissue, and polyps. Polyps are small growths of extra tissue, and some polyps can become cancerous. A colonoscopy is what most people think of when it comes to colorectal cancer screening tests.

A huge advantage of a colonoscopy is that your doctor can both detect and remove precancerous lesions during the procedure, helping to prevent cancer in the future.

In addition to being a colorectal cancer screening tool, colonoscopies can detect conditions like Crohn’s disease and ulcerative colitis, too.

Fecal immunochemical test (FIT)

What is a FIT test? It’s an annual stool test that screens for colorectal cancer. The test looks for the presence of hidden blood in your stool, which can be a sign of colon cancer. A FIT test is noninvasive, convenient and done right at home.

Should you get a colonoscopy or a FIT test?

The important thing is that you get screened. Depending on your age, health, personal preferences and risk factors, your doctor can help you decide how to test for colorectal cancer. The best colon cancer screening test is a completed test – which means more people are opting for a FIT test.

But it’s important to know that choosing a FIT test doesn’t mean you’ll never need a colonoscopy. If your FIT test comes back positive, your doctor will recommend a colonoscopy to investigate further.

Blood test for colorectal cancer

While blood tests can’t determine if you have rectal or colon cancer, it can provide your doctor with clues about your overall health that could help them determine if further evaluation for colorectal cancer is needed. They will look at things like your complete blood count, liver enzymes and presence/absence of chemicals that are sometimes produced by colorectal cancers, like carcinoembryonic antigen (CEA).

Now is always the time to cover your colon

Screenings for colorectal cancer save lives. So, don’t delay the conversation around this important preventive care. If you’ve never been screened or have questions about your options, plan to talk with your primary care doctor at your next preventive checkup.

If you’re ready to schedule a colonoscopy, you can make an appointment online for most of our locations. If you’re interested in a FIT test, you can choose a location and call for more information.

And remember, colorectal cancer screening guidelines only relate to people who have no signs or symptoms of colon or rectal cancer.

Pay attention to how you feel and your bathroom habits. Your poop says a lot about your health. So if you have symptoms like blood in your stool, changes in your bowel habits, chronic constipation or abdominal pain, don’t ignore them. They may be signs of cancer or another health condition, so see a doctor right away.