You might think of colorectal cancer as an older person’s disease, but the proportion of cases in people under 50 has jumped from 6% to 11% in less than two decades, an unsettling trend we’ve been reporting on at Bottom Line for some time. To catch up with this frightening news, the American Cancer society has finally updated its guidelines for the age at which preventive screenings should begin. What does this actually mean for you? Here’s what you need to know now.


We can’t say it enough: Colorectal cancer is a big killer, the third leading cause of cancer-related deaths in men and women in the United States. The positive news is that, when detected in its early stages, it’s highly treatable and often curable. So, in view of the rise in cases among young people and after reviewing studies on colorectal cancer and projecting the risks and benefits with scientific models, the American Cancer Society revised its screening guidelines in May 2018 to say that…

  • If you’re at average risk, start screenings at age 45. That’s five years earlier than previously recommended.
  • If you’re over 50 and at average risk, the guidelines haven’t changed: Get regular screenings every 10 years through age 75.
  • If you’re between 76 and 85 and are in good health, decide with your doctor what screening methods and intervals are right for you.
  • After 85, you likely can stop screening.

However, if you have any particular risk factors for colon cancer, you may need to start earlier and screen more frequently. Key risk factors include obesity, a sedentary lifestyle, smoking and heavy drinking. Having a personal or family history of inflammatory bowel disease such as Crohn’s, polyps or type 2 diabetes also increase your risk. African-Americans, Native Americans and Jewish people of Eastern European descent are also at higher risk. Talk to your doctor to work out a screening plan that’s best for you.

The American Cancer Society stopped short of recommending one type of colorectal cancer screening over another. The idea is that the best one for you is the one you will actually have. That being said, colonoscopy is the gold standard for colon cancer screening because it looks at the greatest length of colon as well as allowing the doctor to remove any suspicious growths as part of the process. Because many people are put off by it (and the prep) and won’t do it, the American Cancer Society says that an acceptable option is a test that looks for signs of cancer in a sample of your stool. Remember, though, if the stool-based test is positive, you will need a colonoscopy to find out the cause.


  • Colonoscopy every 10 years
  • CT colonography (virtual colonoscopy) every 5 years
  • Flexible sigmoidoscopy every 5 years
  • Fecal immunochemical stool test every year
  • High-sensitivity guaiac-based fecal (stool) occult blood test every year
  • Multi-target stool DNA test every three years

A reminder: No matter your age, if you experience any symptom of colon cancer, such as a change in bowel habits and/or blood in your stool, never ignore it. See your doctor right away.

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