Colorectal Cancer Screening Now Starts at 45: Why the Age Dropped

The change, precisely stated

On May 18, 2021, the U.S. Preventive Services Task Force issued a final recommendation that colorectal cancer screening begin at 45 rather than 50.

The grades matter, because they signal how strong the evidence is:

• Ages 50 to 75: screen everyone. Grade A.
• Ages 45 to 49: screen. Grade B.
• Ages 76 to 85: offer selectively, weighing overall health, prior screening, and the person's own preference. Grade C.

Task Force recommendations carry weight beyond advice, because they often determine what insurers cover without cost sharing.

Why the age moved

The Task Force set out its reasoning plainly.

Colorectal cancer is the third leading cause of cancer death for both men and women in the United States. It cited an estimate of 52,980 deaths in 2021.

Then the number that drove the change: incidence of colorectal adenocarcinoma in adults aged 40 to 49 rose by almost 15% between 2000–2002 and 2014–2016. An estimated 10.5% of new colorectal cancer cases now occur in people under 50.

The disease is still mostly one of later life — SEER puts the median age at diagnosis at 66, with most cases between 65 and 74. But the under-50 share grew enough that the old starting line was leaving a real group of people unscreened.

The Task Force also noted a coverage problem. In 2016, 25.6% of eligible adults had never been screened. In 2018, 31.2% were not up to date.

Screening here does something unusual

Most cancer screening finds cancer earlier. Colorectal screening can stop the cancer from happening.

Most colorectal cancers begin as a polyp — a growth on the bowel lining that is not cancer when it appears, and in most cases never becomes cancer. When a colonoscopy finds a polyp, it can usually be removed during the same procedure.

That is prevention, not early detection. Very few screening programs in medicine can do it. Our guide to colorectal cancer screening walks through what each test involves.

The options, and how often

There is more than one acceptable way to screen. The Task Force lists these strategies:

• High-sensitivity guaiac fecal occult blood test (HSgFOBT) or fecal immunochemical test (FIT): every year. Done at home, no bowel preparation, no sedation.
• Stool DNA-FIT: every 1 to 3 years.
• CT colonography: every 5 years.
• Flexible sigmoidoscopy: every 5 years.
• Flexible sigmoidoscopy every 10 years plus annual FIT.
• Colonoscopy: every 10 years.

There is a catch worth understanding. Any abnormal stool or imaging result leads to a colonoscopy anyway. The stool tests are not an alternative to colonoscopy so much as a filter in front of it.

The practical point is that the best test is usually the one a person will actually complete, on schedule, repeatedly. An annual FIT that gets done beats a colonoscopy that gets postponed for a decade.

What stage at diagnosis is worth

For 2026, American Cancer Society projections carried by SEER give 158,850 new United States colorectal cancer cases and 55,230 deaths.

Five-year relative survival by stage at diagnosis:

• Confined to the bowel: 91.3%. This accounts for 34% of cases.
• Spread to nearby lymph nodes: 75.2%. 37% of cases.
• Spread to distant sites: 16.9%. 23% of cases.

Across all stages the figure is 65.4% for diagnoses between 2016 and 2022. These are averages across a large and varied population. They describe a group, not any individual, and they do not account for anyone's particular circumstances.

The spread between 91.3% and 16.9% is the entire argument for screening, in two numbers.

When symptoms change the plan

Screening is for people without symptoms. If you have symptoms, you need assessment, and that is true at any age — 25, 35, or 45. Contact a clinician about:

• Blood in the stool, or stools that look black and tarry.
• A change in bowel habit lasting more than three weeks: looser, more frequent, or newly constipated.
• Abdominal pain or cramping that keeps returning.
• A feeling that the bowel has not emptied after going.
• Unexplained weight loss.
• Fatigue or breathlessness from iron-deficiency anemia, which can be the first sign of slow bleeding.

Do not wait for a screening birthday, and do not accept an assumption that you are too young. The rise in cases under 50 is exactly why that assumption stopped being safe.

Some people should also start earlier than 45 by plan rather than by symptom: those with a family history of colorectal cancer or advanced polyps, an inherited condition such as Lynch syndrome or familial adenomatous polyposis, or inflammatory bowel disease. That is an individual conversation, not a guideline age.

What this does and doesn't change

• The 45 starting age applies to people at average risk. Higher-risk groups have separate schedules that often start earlier and repeat more often.
• Lowering the age does not make screening more effective per test. It widens who gets offered one.
• Grade B for ages 45 to 49 is a real recommendation, but it reflects somewhat less certain net benefit than the Grade A for ages 50 to 75.
• No screening test catches everything. A normal result lowers the odds; it does not make symptoms unimportant afterward.
• This page describes recommendations current at the source-check date. Guidance is revised, so confirm the present advice with a clinician. Our colorectal cancer page covers what happens after an abnormal result.

Sources

• U.S. Preventive Services Task Force, Colorectal Cancer: Screening, final recommendation statement, May 18, 2021: https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/colorectal-cancer-screening
• National Cancer Institute, Screening Tests to Detect Colorectal Cancer and Polyps: https://www.cancer.gov/types/colorectal/screening-fact-sheet
• National Cancer Institute, Colorectal Cancer Screening (PDQ), health professional version: https://www.cancer.gov/types/colorectal/hp/colorectal-screening-pdq
• SEER Cancer Stat Facts, Colorectal Cancer: https://seer.cancer.gov/statfacts/html/colorect.html

How this page was made

An AI-assisted editorial system helped prepare this page. No named medical reviewer has reviewed it unless one is listed.

The National Cancer Information Foundation publishes Cancer Explained. It is not a diagnostic service, does not recommend treatments, and is not for emergencies.

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