USPSTF lowers the recommended colorectal-cancer screening age to 45

Five years earlier

On May 18, 2021, the U.S. Preventive Services Task Force moved the starting age for colorectal cancer screening from 50 to 45.

The change is narrower than it sounds. Screening for adults 50 to 75 keeps a Grade A. The new part, ages 45 to 49, gets a Grade B. Both grades sit inside the set that insurers must cover with no cost sharing.

For ages 76 to 85, nothing moved. That remains a Grade C: screen selectively, weighing overall health, life expectancy, other conditions, previous screening and what the person wants. After 85, the Task Force says screening should stop.

Why the age moved

The Task Force set out its reasons in the recommendation itself.

Colorectal cancer was the third leading cause of cancer death for both men and women, with about 52,980 deaths projected in the United States in 2021. It is diagnosed most often between 65 and 74.

But an estimated 10.5 percent of new cases occur in people under 50. And the incidence of colorectal adenocarcinoma in adults aged 40 to 49 rose by almost 15 percent from 2000 to 2002 compared with 2014 to 2016.

The Task Force also noted how many people were not screened at all. In 2016, 25.6 percent of eligible U.S. adults had never been screened. In 2018, 31.2 percent were not up to date.

Which test counts

The Task Force does not pick one test. It lists strategies that all count as screening, and the choice is meant to be a conversation.

Stool-based tests:

• A high-sensitivity guaiac fecal occult blood test, or a fecal immunochemical test known as FIT, every year.
• A stool DNA test combined with FIT every 1 to 3 years.

Direct-visualization tests:

• Colonoscopy every 10 years.
• CT colonography every 5 years.
• Flexible sigmoidoscopy every 5 years.
• Flexible sigmoidoscopy every 10 years plus a FIT every year.

Each has a different burden. Stool tests are done at home and need no bowel prep, sedation or transport, but they need doing again and again. Colonoscopy needs prep, sedation and a ride home, and carries small risks of bleeding and perforation that rise with age. It is also the only one where a polyp found can be removed in the same visit. Our guides to stool tests and colonoscopy cover each in detail.

One rule applies to every non-colonoscopy option. An abnormal result is not the end of the screen. The Task Force is explicit that the benefit of screening is only achieved when a positive stool test or an abnormal sigmoidoscopy or CT colonography is followed by a colonoscopy.

Who is at higher risk

Age is the single largest factor. Nearly 94 percent of new cases occur in adults aged 45 or older.

Rates run higher in Black adults and in American Indian and Alaska Native adults, in men, and in people with a family history of colorectal cancer even without a named inherited syndrome. Obesity, diabetes, long-term smoking and heavy alcohol use also raise risk.

The recommendation covers people at average risk. It does not apply to people with inflammatory bowel disease, a previous colorectal cancer or polyp, or a syndrome such as Lynch syndrome or familial adenomatous polyposis. Those groups follow different, closer surveillance.

When to get checked

Screening assumes no symptoms. NCI lists what should prompt an appointment whatever your age:

• Blood in the stool, either bright red or very dark.
• A change in bowel habits, including diarrhea or constipation.
• A feeling that the bowel does not empty completely.
• Stools that are narrower or a different shape than usual.
• Ongoing gas pain, bloating, fullness or cramps.
• Weight loss for no known reason, fatigue, or vomiting.

These have many causes other than cancer. They still need looking at rather than waiting for the next scheduled test. Our page on colorectal cancer symptoms goes through each one.

The group picture

SEER figures describe the United States population, not any individual.

Five-year relative survival for colorectal cancer is 65.4 percent for cases from 2016 to 2022. By stage it is 91.3 percent while the cancer is confined to where it started, 75.2 percent once it reaches nearby lymph nodes, and 16.9 percent once it has spread further.

That gap is the whole case for screening. Only 34 percent are found at the first stage, and 23 percent are already distant. The American Cancer Society projects 158,850 new cases and 55,230 deaths for 2026, a forecast SEER republishes, and the median age at diagnosis is 66.

What this does not mean

It does not mean 45 is the right age for everyone. Anyone with a family history or a bowel condition may need to start earlier, on a different schedule.

It does not mean a colonoscopy. The Task Force certified six strategies, and the one most likely to actually get done is often the right one.

And a recommendation is not a service. The screening advice changed in 2021, but access, transport, bowel prep and time off work all sit between the advice and the appointment.

Sources

• USPSTF, Colorectal Cancer: Screening (final recommendation, May 18, 2021) — https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/colorectal-cancer-screening
• USPSTF, Final Recommendation Statement: Screening for Colorectal Cancer — https://www.uspreventiveservicestaskforce.org/uspstf/announcements/final-recommendation-statement-screening-colorectal-cancer-0
• NCI PDQ, Colon Cancer Treatment (Patient Version) — https://www.cancer.gov/types/colorectal/patient/colon-treatment-pdq
• SEER Cancer Stat Facts, Colorectal Cancer — https://seer.cancer.gov/statfacts/html/colorect.html

How this article was prepared

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. This page is for learning. It is not medical advice and does not suggest a test or treatment.

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