Sad man sitting and holding his stomach

Colon Cancer Screening Guidelines


  • Colon cancer screening guidelines are dictated by risk, patient comfort, age, and other factors.
  • People at high risk of colon cancer may need to do more types of screenings and test more frequently.
  • Early stages of colon cancer often produce no symptoms, which is why you should consider screening early regardless of age.

Colon cancer screening guidelines are a useful tool for determining how often you should test for colorectal cancer. Guidelines are based on age and risk factors and differ depending on whether you are at average or high risk for the disease. 

Why Do I Need Regular Colon Cancer Screenings?

Colon cancer is a difficult disease to diagnose in its early stages due to either a lack of symptoms or common symptoms that overlap with other illnesses. You’re most likely to experience diarrhea or constipation, changes in the color and shape of your stool, bloating and cramping, and blood in the toilet or in your feces.

Even doctors can mistake early-stage colon cancer for a stomach bug or a chronic condition, particularly if you’re only experiencing one or two of those symptoms. What’s more, our risk of colon cancer goes up as we age. Catching colon cancer in its early stages means it is easier to treat with less invasive and safer methods, raising the odds of both remission and survival. It also requires less time in the hospital and less postoperative care, improving your quality of life.

Determining Colon Cancer Risk

Endoscopy procedure

When and how to screen for colon cancer depends on your risk level, which is either “average” or “high.” You’re considered at average risk of colon cancer if:

  • You’ve had no inflammatory bowel disease at any point.
  • You have no family history of colon cancer.
  • You’ve never been diagnosed with colon cancer and have never had a precancerous lesion or polyp removed.
  • You’ve never used radiation to treat another type of abdominal cancer.
  • You don’t have any hereditary syndromes that may elevate your risk of colorectal cancer.

You’re considered at high risk of colon cancer if:

  • You have a family history of colon cancer, especially of aggressive cancer or onset at a young age. 
  • You’ve had polyps (benign or precancerous) removed during a regular screening,  particularly if they’ve obstructed your colon.
  • You’ve had other cancers in the past — especially abdominal cancers — that were treated with radiation.
  • You have a hereditary syndrome that increases your risk.

Certain factors unique to you can affect this determination. For example, being a smoker or drinking heavily may put you in the high-risk category regardless of other circumstances. 

Colon Cancer Screening Guidelines by Risk Profile

Woman laying on hospital bed

Colorectal cancer screening guidelines are based on your risk profile. 

Recommendations for Average-Risk Individuals 

For people of average risk, the American Cancer Society recommends the following:

  • You should begin screening regularly at age 45. You can use either a high-sensitivity stool test or schedule a visual exam via colonoscopy. High-sensitivity tests should be done every two years. Routine colonoscopies are recommended every ten years, but if something unusual comes back on your stool test, you’ll likely need a colonoscopy to determine if it’s a problem.
  • You should continue these tests until you reach the age of 75. At that point, you and your doctor would discuss whether screening is necessary based on your overall health, life expectancy, and the results of your previous screenings.
  • At age 85, screenings are generally discontinued to avoid unnecessary over-testing.

Recommendations for High-Risk Individuals 

If you’re at high risk, you’ll need to work out a testing regimen with your doctor. The tests you’ll use and their frequency will depend on risk factors like your demographic profile and what type of cancer you’re most at risk for. For example, African-American men are at disproportionate risk for bowel cancer, so they might benefit from a more aggressive testing regimen. 

Screening recommendations will also depend on the tests you’re most comfortable with, how effective those tests are, and their cost. The U.S. Multi-Society Task Force on Colorectal Cancer recommends a tiered approach based on those factors, prioritizing the fecal immunochemical test (FIT) and colonoscopy.

In general, it’s recommended that this process start at age 45, although some groups at high risk should start at age 40 or earlier. Testing usually ends at age 85.

Guidelines for Colorectal Cancer Screening for People Under 45

Surgery in progress

Colorectal cancer is the most fatal form of cancer in American men under 49 and the third most fatal cancer in women under 49. Colorectal cancer rates have dropped in older populations because of decreased smoking rates and growing screening awareness, but they’re rising in younger groups.

Colorectal cancer is still rare in younger people, but if you suspect you may be at high risk, talk to your doctor about screening. You should also consider screening if you are overweight or at risk of a chronic condition such as diabetes.

Can I Screen More Often Than Recommended?

The rising availability, dropping cost, and ease of use of at-home colorectal cancer screening kits have made more frequent testing feasible. Many people consider annual testing, but does it make sense? More frequent testing is an option, but before you decide, ask yourself two questions.

First, what’s your overall risk profile? If you’re at average risk, then there may not be a reason to perform tests more often than outlined above. If you’re at high risk, however, more regular testing may be appropriate.

Second, will screening give you peace of mind? The guidelines above are developed to put patients at ease without overdiagnosing them. Will taking a test make you feel better? If you’re in a high-risk group, annual at-home screening may make sense for you.

Colon Cancer Screening Saves Lives

Regular colorectal cancer screening is an easy and effective way to protect your health. Understanding your risk and acting early helps you catch colon cancer before it spreads, improving your chance of survival. Follow the eDrugstore blog to learn more about colon cancer screening and at-home testing.

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