Lowering the Colorectal Cancer Screening Age for Average Risk Individuals

Human colon cancer, CRC
Investigators assessed the prevalence of and risk factors for colorectal neoplasia among patients aged 18 to 54 years.

Experts recommend lowering the colorectal cancer (CRC) screening initiation age to 45 years for individuals at average risk, according to a study published in Gastroenterology.

Due to an increase in early-onset colorectal cancer (EOCRC), recent guidelines have recommended lowering the CRC screening initiation age from 50 to 45 years for average risk individuals. As little is known about the prevalence of colorectal neoplasia in individuals aged between 45 and 49 years in the United States, and in even younger populations, researchers analyzed a large, nationally representative dataset of almost 3 million outpatient colonoscopies to determine the prevalence of and risk factors for colorectal neoplasia among patients aged 18 to 54 years.

In total, investigators determined 562,559 screening or diagnostic colonoscopies were performed and met inclusion criteria based on quality; 145,998 procedures were performed in patients aged 18 to 44 years, 79,934 in those aged 45 to 49 years, and 336,627 in those aged 50 to 54 years. More women underwent colonoscopies across all age groups. The majority of patients were White.

Investigators found that the overall prevalence of any neoplasia and advanced premalignant lesions (APL) gradually increased from 2014 to 2020 among all age groups. However, among patients aged 45 to 49 years, 32% had any neoplasia, 7.5% had APLs, and 0.58% had CRC; these rates were almost as high in those aged 40 to 44 years. Rates of CRC and APLs in patients with a family history of CRC were similar to those of patients aged 5 years older without a family history.

In particular, increasing age, male sex, White race, family history of CRC, and examinations for bleeding or screening were all associated with higher odds of APLs and CRC. Compared with their White counterparts, the rates of APLs were found to be higher in Asian and American Indian/Alaskan Native populations, but lower among Black and Hispanic populations.

Investigators acknowledge bias due to insurance coverage may be present in study results. Additionally, data related to pathological findings and location of cancer within the colon were unavailable.

“The present analysis of neoplastic colorectal pathology among individuals younger than age 50 suggests that lowering the screening age to 45 for men and women of all races and ethnicities will likely detect important pathology rather frequently,” concluded the researchers. They added, “Early messaging to patients and providers in the years leading up to age 45 is warranted, especially in those with a family history of CRC.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 


Trivedi PD, Mohapatra A, Morris MK, et al. Prevalence and predictors of young-onset colorectal neoplasia: Insights from a nationally representative colonoscopy registry. Gastroenterol. Published online January 7, 2022. doi: 10.1053/j.gastro.2021.12.285