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Colorectal Cancer Screening Saves Lives – But How Soon Should You Start?

Man Speaking to a Doctor
Man Speaking to a Doctor

Health care experts now recommend that people at average risk for colorectal cancer begin screening at the age of 45. 

Colorectal cancer (CRC)is the third most common cancer worldwide. According to the Public Health Agency of Canada, 1 in 14 Canadian men is expected to develop CRC within their lifetime, and more than 5,000 die from the disease every year (numbers are slightly lower for women).1

Yet, CRC can be one of the most preventable and treatable cancers thanks to screening.

The National Comprehensive Cancer Network® (NCCN®) publishes evidence-based expert consensus guidelines that are used worldwide. It’s one of many health organizations that has recently moved the screening age for CRC to start at 45 in response to a small-but-significant increase in CRC cases in people under the age of 50.

Screening options include visual screening (e.g., colonoscopy) and stool-based screening (e.g., fecal immunohistochemical test [FIT]). These screening options are all effective for detecting CRC but have different levels of cost and invasiveness — people should talk with their doctor about which method is the best for them. 

Recent data modeling suggests that lowering the screening age to 45 increases the number of life-years gained across all screening methods.2 However, more than half of patients who develop CRC before age 50 start having symptoms even younger. Therefore, anyone experiencing iron deficiency anemia, rectal bleeding, or a concerning change in bowel movements should undergo a colonoscopy no matter their age. People with a personal or family history of CRC, ulcerative colitis, Crohn’s disease, or cystic fibrosis, are considered at increased risk — those with Lynch syndrome or inherited polyposis syndromes are at even higher risk — and should also begin screening sooner.

CRC screening is one of the most effective cancer prevention tools we have. I encourage everyone to learn more about their own risk and work with their health care team to figure out which screening approach is the best for them. 

Headshot of Dr. Reid Ness

Reid M. Ness, MD, MPH

Associate Professor of Medicine, Vanderbilt-Ingram Cancer Center & Chair, NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Panel for Colorectal Cancer Screening



2Peterse, Cancer 2018;124:2964-73

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