Colorectal Cancer Screening Starts at 45
If you’re 45 or older, colorectal cancer screening is recommended for you — not because you have symptoms, but because you’ve reached the age where the benefits of routine screening outweigh the risks for the average person. This page covers why the age changed, what the options actually involve, and what to do if you’re overdue.
- The recommended screening age in the US was lowered from 50 to 45 in 2021, in response to rising rates of colorectal cancer in younger adults.
- Screening applies to people without symptoms — it’s not the same as being evaluated for a symptom you’re already having.
- There are several screening options, from an at-home stool test to a colonoscopy, and they differ in frequency, invasiveness, and what they can detect.
- A family history of colorectal cancer or polyps may mean you should start screening earlier than 45 — this is worth asking your doctor about directly.
Why the age changed
In May 2021, the U.S. Preventive Services Task Force lowered its recommended starting age for colorectal cancer screening in average-risk adults from 50 to 45. The change followed a documented rise in colorectal cancer diagnoses among adults under 50 over the preceding decades — a trend that had been building for years before the guideline caught up to it. The American Cancer Society had already recommended starting at 45 since 2018, and gastroenterology societies in the US aligned their own guidelines with the lower age around the same time.
This matters for this site specifically because rectal bleeding and changes in bowel habits — the exact symptoms often assumed to be hemorrhoids — are also symptoms of colorectal cancer. Being in the newly expanded screening group is a good reason to mention both things to your doctor at once, rather than treating “I think it’s hemorrhoids” and “should I be screened” as two separate conversations.
Screening vs. being evaluated for a symptom
These are related but different. Screening is for people without symptoms, done on a schedule based on age and risk. Diagnostic evaluation is what happens when you already have a symptom — like bleeding — that needs to be worked up regardless of whether you’re due for routine screening. If you have symptoms, don’t wait for a scheduled screening date; see a doctor about the symptom directly. See Rectal bleeding: what it can mean.
Your options
Screening isn’t one single test — there are several, and the right one depends on your preferences, risk level, and what your doctor recommends:
| Test | How often | What it involves |
|---|---|---|
| Colonoscopy | Every 10 years (average risk) | Full exam of the colon under sedation; can remove polyps during the same procedure |
| Stool-based tests (FIT, FIT-DNA) | Annually (FIT) or every 1–3 years (FIT-DNA) | At-home sample test for hidden blood or DNA changes; positive results need a follow-up colonoscopy |
| CT colonography | Every 5 years | Imaging-based exam of the colon; less invasive than colonoscopy but still requires bowel prep, and any findings need follow-up colonoscopy |
| Flexible sigmoidoscopy | Every 5 years (sometimes paired with annual FIT) | Examines the lower portion of the colon only, not the full length |
None of these is inherently “better” for everyone — a stool test you’ll actually do every year can catch things a colonoscopy you keep postponing won’t. The point of having multiple options is to make it more likely you get screened at all.
If you’re already 45+ and haven’t been screened
This is common, and it’s not too late to start. The most direct step is to bring it up at your next doctor’s visit — including one for an unrelated or hemorrhoid-like symptom — and ask which option makes sense for you. If cost or insurance coverage is a concern, most private insurance plans are required to cover screening with no out-of-pocket cost when it has this recommendation level, though it’s worth confirming with your specific plan.
If you have a family history
A family history of colorectal cancer or polyps — especially in a parent, sibling, or child — can mean you should start screening before 45, and possibly with a different test or frequency. This is a specific conversation to have with your doctor rather than something to determine from a general guideline; bring up exactly who was affected and at what age, if you know it.
What screening does not require
Screening doesn’t require you to already suspect something is wrong, and a normal result doesn’t mean the screening was unnecessary — the entire point is catching things before they cause symptoms, at a stage when they’re most treatable.
This page is for general education and reflects general screening guidance as of 2026. Screening recommendations can vary based on individual risk factors — talk to your doctor about what’s right for you.