Colorectal cancer screening: At what age should I get a colonoscopy?

Colorectal cancer screening can detect cancer early, giving you the greatest chance for successful treatment. While colonoscopy is the gold standard for colorectal cancer screening, you may be wondering when you should get your first test.

We spoke with gastroenterologist Mazen Alasadi, M.D., about the recommended age for colonoscopies.

Most people should get their first colonoscopy at age 45

Current guidelines suggest that you should get your first colonoscopy at age 45 if you are at average risk for colorectal cancer. If no polyps are found during your initial colonoscopy, then you wouldn’t need your next colonoscopy for another 10 years.

Regular screenings are recommended from age 45 through 75.

High-risk groups should start screening earlier

Individuals at higher risk for colorectal cancer should begin getting a colonoscopy earlier than age 45.

If you have a first-degree relative (e.g., parent or sibling) with a history of colorectal cancer, you should get your first colonoscopy at age 40, or 10 years younger than the age at which the family member was diagnosed, whichever is earlier.

Other groups who may need a colonoscopy sooner include those with:

• inflammatory bowel disease or
• inherited genetic changes, such as Lynch syndrome and familial adenomatous polyposis (FAP). Colonoscopy screening for people with FAP can begin as early as age 10.

Consult your doctor about colorectal cancer screening after age 75

While colonoscopies are still recommended for some people older than 75, speak with your doctor to determine if you should continue colorectal cancer screening after age 75.

Your body changes as you age, and for some people, a colonoscopy after age 75 isn’t recommended.

“Having a colonoscopy at age 45 is different than having one at age 75,” says Alasadi. “We consider it on a case-by-case basis.”

For example, some individuals over age 75 want to have another colonoscopy because their doctor found precancerous polyps during their previous colonoscopy. Or a patient could have a family history of colorectal cancer.

Or maybe you’ve begun to develop colorectal cancer symptoms.

“Let’s say you’ve been doing fine and suddenly at age 76, you begin to notice blood in your stool,” says Alasadi. “We don’t know if this could be related to hemorrhoids, diverticulosis or colorectal cancer. We might recommend a colonoscopy, so we can determine the cause of the bleeding.”

Older patients are also more likely to have comorbidities, meaning they have two or more diseases or medical conditions at the same time. For example, a patient older than 75 with heart disease, high blood pressure, diabetes and on blood thinners would need to disclose these conditions as well as current medications to their doctor.

“If a patient is on blood thinners, they have to stop taking that medication before receiving a colonoscopy,” says Alasadi. “I always get this cleared by the patient’s cardiologist or hematologist before the procedure.”

There’s also a greater risk to older people while undergoing anesthesia, so it’s important to consider the anesthesia administered during a colonoscopy.

“We always discuss the risks and benefits of the colonoscopy with each patient,” says Alasadi. “Once we explain all of these things, the patient signs a consent form before we proceed with the colonoscopy.”

MD Anderson doesn’t recommend colorectal cancer screening for people older than 85.

“If you don’t have any more problems or symptoms, you don’t need to have any more colonoscopies,” says Alasadi.   

Request an appointment at MD Anderson online or by calling 1-877-632-6789.