July 2026
Colorectal cancer is the third most common cause of cancer-related deaths in women, and the fourth most common in men, according to the American Cancer Society. But while deaths from colorectal cancer have been falling at a rate of 1.5% per year for those 55+, they have been increasing at a rate of 1% per year for those under 55.
The most likely explanation for this phenomenon is routine colorectal screening in older people. Routine screening can catch pre-cancerous polyps, which can then be removed before they progress to cancer. And when cancer is found, regular screening means it’s often found earlier, when it’s easier to treat.
Learn more about when you should get screened, plus what your testing options are.
When should you start getting screened for colorectal cancer?
When you should get your first colonoscopy depends on your age and whether or not you have any risk factors.
- No identified risk factors: Screening should begin at age 45. This is younger than the previous recommendation of beginning at age 50. The U.S. Preventive Services Task Force (USPSTF) made this change in 2021 because rates of colorectal cancer deaths in people under 50 have been increasing by 1% each year since 2004.
- Family history of colorectal cancer. Screening should begin 10 years before the age of diagnosis of the youngest family member that had colorectal cancer. For example, if you had a parent diagnosed at age 45, you should begin screening at age 35. (If none of your family members were diagnosed until after the age of 55, you should begin screening at age 45.)
- Lynch syndrome. This is the most common hereditary colorectal cancer syndrome. People with Lynch syndrome have a high lifetime risk of colorectal cancer — between 10% and 80%, depending on which gene is involved. If you have Lynch syndrome, you should begin screening in your early 20s or 2 to 5 years before the youngest family member’s diagnosis, whichever comes first. Colonoscopy should be repeated every 1 to 2 years.
- Familial adenomatous polyposis (FAP). This is the second most common hereditary colorectal cancer syndrome. FAP causes hundreds to thousands of polyps to develop in the colon, often beginning in the early teen years. Without treatment, nearly 100% of people with FAP will develop colorectal cancer, mostly before age 50. Screening with colonoscopy should begin between the ages of 10 and 15.
- Other high-risk factors. Obesity, excessive alcohol use, smoking, diabetes, and inflammatory bowel disease (IBD) — including Crohn’s disease and ulcerative colitis — increase your risk of colorectal cancer. If you have one or more of these risk factors, talk to your doctor about whether you should begin screening before age 45.
- Symptoms of colorectal cancer. Common symptoms include blood in the stool or rectal bleeding, a persistent change in bowel movements (such as diarrhea, constipation, or narrowing of the stool lasting more than a few days), and abdominal cramping or pain. Other possible symptoms include unexplained weight loss and unusual fatigue. If you are experiencing any of these, talk to your doctor. A colonoscopy can help rule out cancer as a cause or catch it early if it’s present.
