USPSTF Recommends Starting Colorectal Cancer Screenings at Age 45

An illustration of healthcare professionals in a clinic doing a colonscopy.


Key Takeaways

  • The United States Preventative Services Task Force (USPSTF) has updated its guidelines for colorectal cancer screenings. Individuals at average risk for colorectal cancer should start having routine screenings at age 45.
  • The previous recommendation was for routine colorectal cancer screenings to begin at age 50; however, with more cases being diagnosed in younger people, the task force decided to change the guidelines.
  • Depending on your risk factors, you have several options for your colorectal cancer screening—including colonoscopies and at-home tests.

The United States Preventative Services Task Force (USPSTF) has updated its recommendation on colorectal cancer screening. It now recommends that individuals at average risk for colorectal cancer begin routine screenings at age 45 instead of 50.

The new guidelines, which were published in the Journal of the American Medical Association, are in line with those of the American Cancer Society.

Are You Average Risk?

Being at average risk for colorectal cancer means that you do not have certain risk factors. You are

are considered at average risk if you do not have:

  • A personal history of colorectal cancer or certain types of polyps
  • A family history of colorectal cancer
  • A personal history of inflammatory bowel disease (such as ulcerative colitis or Crohn’s disease)
  • A confirmed or suspected hereditary colorectal cancer syndrome, such as familial adenomatous polyposis (FAP) or Lynch syndrome (hereditary non-polyposis colon cancer or HNPCC)
  • A personal history of receiving radiation to the abdomen or pelvic area to treat a prior cancer

If you have one or more of these factors, you would be considered at higher risk for colorectal cancer. Talk to your doctor about the screening guidelines that are best for you.

Colorectal Cancer in Younger People

New cases of colon cancer in individuals younger than 50 have been increasing over the last 20 years and rose even more sharply between 2010 and 2020. These increases prompted the USPSTF to update its guidelines for screening.

Early detection also improves a person's odds of surviving colorectal cancer. The USPSTF estimates that someone who is diagnosed with colorectal cancer between the ages of 45 and 50, can expect an additional 22 to 27 years of life expectancy.

“We are so thrilled the USPSTF has changed the guidelines because we are seeing an uptick in younger cases, and the more we can find, the more we can cure,” Karen Winkfield, MD, PhD, Executive Director of the Meharry-Vanderbilt Alliance, and a member of the Stand Up To Cancer Committee for Health Equity in Cancer Clinical Trials tells Verywell. “There are a few cancers that we can cure, and colorectal cancer happens to be one of them if it’s caught early enough. About 90% of cases are beatable.”

At-Home Screening

When you think of a colorectal cancer screening, you probably think about having to go to the hospital to have a colonoscopy. While this is one way that people can be screened, there are now more options for people who are not considered high-risk.

Karen Winkfield, MD, P.h.D.

There are a few cancers that we can cure, and colorectal cancer happens to be one of them if it’s caught early enough.

— Karen Winkfield, MD, P.h.D.

At-home stool tests are a convenient, non-invasive way to screen for colorectal cancer in people at average risk. In the last year, the option has been especially useful.

Kevin Conroy, CEO for Exact Sciences, the creator of the Cologuard test, said in a statement that “particularly during the COVID-19 pandemic when healthcare access has been limited, and cancer screenings have been harder to complete, Cologuard has been a convenient screening option for individuals at average risk for colorectal cancer.”

Should You Have a Colonoscopy Instead?

At-home screening tests for colorectal cancer are an option for many people at average risk, but Winkfield stresses that colonoscopies provide an opportunity to prevent future cases of colorectal cancer.

“We know exactly the steps that are necessary for a polyp to become a cancer," says Winkfield. "If there’s a polyp that’s found, that polyp being removed is a wonderful thing because you have just now prevented colorectal cancer.”

If you have risk factors, like a family history of colorectal cancer or a personal history of certain medical conditions that increase your risk, your doctor might want you to have a colonoscopy rather than do a test at home.

Advocate For Your Health

If you're not sure what your risk for colorectal cancer is or you don't know which type of screening would be best for you, it's important to talk to your doctor about your options—because you do have them.

In addition to its updated guidance, the USPSTF has also recommended measures that it believes will improve ready access to colorectal cancer screenings, such as:

  • Bundling the FIT stool test with yearly flu shots
  • Employer-sponsored “wellness days” for colonoscopies
  • Evening and weekend hour appointment times for colonoscopies
  • Providing transportation assistance for those who do not have a support person to drive them home after a colonoscopy

While doctors need to discuss cancer screening measures with their patients, everyone needs to be an advocate for their own health.

"It’s really important for individuals who are reaching the age of 45 to have a conversation with their provider," says Winkfield. "This is one cancer we know that we can prevent with screening. We have more options for screenings, it’s really helpful to know about them because these are important tools."

What This Means For You

Colorectal cancer is on the rise in younger people, but early detection through routine screening can help diagnose it sooner and improve survival odds. Talk to your doctor about your risk for colorectal cancer and the type of screening that's best for you.

1 Source
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Knudsen AB, Rutter CM, Peterse EF, et al. Colorectal Cancer Screening: A Decision Analysis for the US Preventive Services Task Force. Agency for Healthcare Research and Quality; 2021. AHRQ publication 20-05271-EF-2.

By Cyra-Lea Drummond, BSN, RN
 Cyra-Lea, BSN, RN, is a writer and nurse specializing in heart health and cardiac care.