Overview
- Clinicians are urging colonoscopy before age 45 for those with a first-degree relative with colorectal cancer, often starting at 40 or 10 years earlier than the youngest affected relative.
- People with inherited syndromes such as Lynch syndrome or familial adenomatous polyposis need much earlier and more frequent surveillance, commonly beginning in the teens or 20s with 1–2 year intervals.
- Three in four patients under 50 are being diagnosed at regional or distant stages, a pattern linked to symptoms being minimized or misattributed in younger adults.
- The U.S. Preventive Services Task Force now advises routine screening from age 45 for average-risk adults, but persistent rectal bleeding, bowel habit changes, abdominal pain, unexplained anemia, or weight loss warrant prompt colonoscopy at any age.
- Native American and Alaska Native people face the highest risk, with elevated risk also reported for African Americans, highlighting the need for targeted outreach and access to screening.