Colonoscopy is a screening tool to detect colorectal cancer (CRC), a potentially life-threatening condition. We are fortunate to colonoscopy, because the sooner we can identify cancer, the sooner it can be treated, and potentially cured.

Thanks to colonoscopies, the number of adults ages 55 and older who were diagnosed with or died from CRC has dramatically decreased. When traditional screening strategies were first instituted in the United States, the recommended age to start routine screening for CRC with colonoscopy was age 50. 

At what age should you get your first colonoscopy?

In early 2021, the American Cancer Society updated their recommendations to start routine colorectal screening with colonoscopy at age 45 for individuals at average risk. For those with an increased risk such as a family history of CRC, the age may be younger and should be discussed with your gastroenterologist. 

Why is the age recommendation for colonoscopy lower? 

In 2017, the American Cancer Society published a study that showed an increase in CRC in adults younger than age 55 who were diagnosed between 1994 and 2014. In addition, there was an increase in younger people who died from CRC from 2005 to 2015 when compared to 1990. These individuals would not be part of the target population who were encouraged to start screening at the traditional recommended age of 50. 

Younger patients with colorectal cancer

Unfortunately, I see quite a few people in my practice who have been diagnosed with colorectal cancer under the age of 50. The youngest patient I have personally treated was diagnosed at age 26. Though we have seen this increased incidence in younger patients, it is not yet clear what has caused this trend. Some think it might be due to lifestyle factors that are known to increase risk of colon cancers, such as obesity, higher consumption of red and processed meats and other highly processed foods and lower consumption of fruits and vegetables.


Signs of colorectal cancer to watch for

The best way to approach CRC is by screening when an individual is completely asymptomatic, that is, without symptoms or issues. If you experience any of the following, you should discuss them promptly with a health care provider:

  • unintentional weight loss
  • consistently visible blood in the stool or black bowel movements
  • new or worsening abdominal pain that is persistent for more than two weeks
  • new abnormal bowel pattern (change in stool frequency or consistency) that is worsening over two or more weeks without other explanation

If you have any of these concerning symptoms, a screening colonoscopy is no longer appropriate. These issues require a full diagnostic workup depending on your symptoms.

Why colonoscopy is a valuable screening tool

  • Screening tools are valuable if they help to identify serious diseases. CRC is serious. It is the second leading cause of cancer death, causing over 50,000 deaths annually. According to the Journal of the National Cancer Institute, it is the third most common cancer among both men and women in the United States. 
  • The ideal screening tool is safe and effective at detecting early-stage disease, with low chance of a “false negative” (negative test results when you have the disease) or “false positive” (a positive test even when you do not have the disease). Colonoscopies are still the best test to screen for colon cancers since it allows us to directly visualize the colon. We can not only diagnose cancers, but also identify precancerous lesions that can be fully removed as polyps before developing into cancers.
  • Colonoscopy allows us to treat earlier stage disease, which is more effective than when treatment is delayed to later stages, when symptoms typically appear. Individuals who are diagnosed with Stage I and early Stage II cancer, where cancer is limited to colon, may be cured with surgery alone. CRC at these stages is associated with a five-year survival rate of greater than 85 percent. Those patients who are diagnosed with Stage IV disease, meaning it has spread to other organs, are generally not able to be cured. In this case, average five-year survival rates are about 12 to 15 percent.

How to reduce your risk of colorectal cancer

In addition to regular screening, changes in your lifestyle may reduce your risk of CRC. Those include:

  • quitting smoking or abstaining from tobacco use altogether
  • a diet high in fruits and vegetables
  • reducing your intake of red and processed meats
  • minimizing your alcohol intake
  • a healthy body weight
  • regular physical activity and exercise

Living a healthy lifestyle will not only help you reduce your risk of CRC, but it will also help you achieve better overall health and well-being.

Visit our website to schedule a colonoscopy or to learn more about gastroenterology services at Lifespan.

Rimini Breakstone, MD

Rimini Breakstone, MD

Dr. Rimini Breakstone a medical oncologist who specializes in gastrointestinal cancers at the Lifespan Cancer Institute