When should colorectal screening start, and do I need colonoscopy?
U.S. recommendations start colorectal screening at 45 for average-risk adults without symptoms, but colonoscopy is not the only option. Symptoms or family history may require earlier assessment; the plan should follow local guidance and individual risk.
Details
Screening differs from investigating symptoms
Blood in stool, persistent bowel changes or unexplained weight loss needs assessment at any age. Do not wait until 45 if a problem develops. Screening schedules apply to people without symptoms.
Available approaches
Some programmes use stool tests, with colonoscopy chosen according to preference, results and risk. A positive stool test usually requires follow-up colonoscopy; repeating it merely to obtain a negative result is not an adequate substitute. Follow-up intervals depend on the test and previous findings.
Who needs a different plan?
Tell your clinician about relatives with colorectal cancer and their age at diagnosis, previous polyps, inflammatory bowel disease or inherited syndromes. After 75, decisions become more individualized according to health and screening history. Age alone cannot determine your next test.
Related reading: How should I prepare for a colonoscopy?.