What Age Should You Get a Colonoscopy?

Colorectal cancer diagnoses are on the rise in people under 50. But there’s reason to be hopeful: The number of colorectal cancer-related deaths has been dropping for several decades. That’s thanks to advances in treatments and more regular screenings — like colonoscopies.

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

So, when should you get a colonoscopy? And why? Colorectal surgeon David Liska, MD, weighs in.

At what age should you get your first colonoscopy?

For most people, the colon cancer screening age starts at 45.

“The current recommendation of age 45 is for average-risk individuals,” Dr. Liska says. “That means people who don’t have symptoms, inflammatory bowel disease, family history of colorectal cancer or advanced polyps, or a hereditary predisposition to colorectal cancer.” (More on all that in a moment.)

Age 45 became the baseline in 2021, when it was recommended by the U.S. Preventive Services Task Force — an independent, volunteer panel of experts in prevention and evidence-based medicine. Before that, the recommendation was to start at age 50.

During a colonoscopy, your healthcare provider uses a flexible camera to look inside your colon and rectum. It’s the most effective screening and prevention tool for colorectal cancer.

“Screening, especially with a colonoscopy, not only detects cancer, but it can also help prevent cancer,” Dr. Liska explains. “It allows us to find polyps so we can remove them before they have a chance to turn into cancer.”

People at average risk need a colonoscopy every 10 years. But you may need them more often, depending on your risk factors and your provider’s recommendations.

When to start earlier

Some people need their first colonoscopy earlier than age 45. Why might that be? Let’s dig in.

If you’re having symptoms

Your provider may recommend that you have a colonoscopy before age 45 if you’re experiencing symptoms like:

Rectal bleeding: Blood in your stool (poop) and/or other blood from your rectum are important warning signs that should always be discussed with a provider.
Bowel changes: Note any shift in bowel habits, like severe constipation, unexplained diarrhea or suddenly pooping much more or less than usual.
Stool changes: If the size, shape or consistency of your poop seems consistently different from what it used to be, that’s something to flag for a provider.
Unexplained weight loss: “If you notice that you’re losing weight and don’t have a reason for it, that’s something to bring up with your physician,” Dr. Liska says.
Other symptoms: Seemingly vague symptoms, like abdominal pain and fatigue, can also be symptoms of colorectal cancer.

If you’re experiencing these symptoms, don’t make assumptions about what could be causing them. Instead, reach out to a healthcare provider ASAP to pursue a diagnosis.

“We often see people under 50 who are diagnosed with colorectal cancer after having symptoms for quite some time,” Dr. Liska shares. “When we talk to them about their symptoms, they tell us they thought they were dealing with hemorrhoids or some other benign condition.”

If you’re at high risk

There are a number of risk factors for colorectal cancer — some you can influence on your own and others that are beyond your control. Risk factors you can’t change include:

Age: Your risk goes up as you get older. But don’t think being younger means you’re immune — about 20% of people diagnosed with colorectal cancer are under age 55.
Medical history: Some medical conditions raise your risk, like a history of colorectal polyps, inflammatory bowel disease, Type 2 diabetes and hereditary cancer syndromes, like Lynch syndrome and familial adenomatous polyposis.
Family history: Tell your provider if you know you have a first-degree biological relative with colorectal cancer or polyps. “It might affect when you should start to be screened and how often,” Dr. Liska says.
Racial or ethnic background: “Colorectal cancer rates have historically been high in Black Americans, especially men,” Dr. Liska notes, “and it’s often diagnosed at a later stage, when it’s harder to cure.” You’re also at higher risk if you’re of Indigenous, Native Alaskan and/or Ashkenazi descent.

Risk factors you can try to manage or influence include:

Weight: “Excess body fat may contribute to chronic inflammation, insulin resistance and hormonal imbalances, which can all play a role in cancer development,” Dr. Liska says.
Activity level: Regular physical activity lowers inflammation, improves digestion and reduces stress, all associated with a lower risk of colorectal cancer.
Diet: You may be at higher risk for colorectal cancer if you eat high amounts of red or processed meats or if you don’t get enough vitamin D in your diet.
Alcohol consumption: Your body breaks alcohol down into acetaldehyde, a chemical known to damage your DNA. Cancer can grow from DNA damage.
Smoking: “Smoking is an incredibly hard habit to break, but quitting may be the most impactful way to reduce your cancer risk,” Dr. Liska emphasizes.

Discuss your colorectal cancer risk factors with healthcare provider.

“The most important thing you can do to prevent this cancer is to have regular screening examinations on the timeline that your provider recommends,” he urges.

At what age is a colonoscopy no longer recommended?

The U.S. Preventive Services Task Force says doctors should use their judgment to “selectively offer screening for colorectal cancer” after age 75. So, ask your healthcare provider what they recommend for you, based on your individual health and risk factors.

Why the change? As you get older, colonoscopies may bring more risks than benefits, especially if you have other health issues. Possible complications include:

Bleeding
Gastrointestinal perforation
Cardiovascular or pulmonary concerns

Final thoughts

If you have concerning symptoms, don’t hesitate to talk to your healthcare provider — regardless of your age. With rates of colorectal cancer on the rise in younger people, early screening is more important than ever. And it can save lives.

If you feel nervous or uneasy about getting a colonoscopy, ask your healthcare provider about that, too. They may share other screening options, like:

Fecal occult blood tests (FOBT) or fecal DNA testing, tests that look for blood and/or genetic alterations in your poop
Sigmoidoscopy, which lets your provider examine the inside of your lower colon and rectum
Virtual colonoscopy, a computed tomography (CT) scan that looks for masses or polyps in your colon and rectum

“Your doctor can answer your questions and talk you through what to expect from a colonoscopy, or they can find a different option for you,” Dr. Liska reassures. “Ultimately, when it comes to your colorectal health, keep this in mind: The best screening test is the one that gets done.”