Prevention belongs in your 40s
45 isn’t early. It’s the starting line.
If you’re 45–75, at average risk, and due for screening, these recommendations already include you. Colorectal cancer means cancer of the colon or rectum.
- Cancer rates are rising in younger U.S. adults.
- Advanced precancer can already be present at the first screening exam.
- Symptoms and family history can change when you need evaluation.
Your next step
Does screening belong on your priority list?
45–75
Average risk
If you haven’t started, arrange screening now. If you have, follow the interval that fits your test and results. After a normal, high-quality colonoscopy, that is commonly 10 years.
Source: Screening guideline
Under 45
Check your risk
A close relative with colorectal cancer or an advanced polyp, an inherited syndrome, inflammatory bowel disease, or your own past polyps may mean starting earlier. Bring your relatives’ diagnoses, and their ages, to your clinician.
Source: Screening guideline · NCI evidence
Any age
Symptoms need evaluation
Rectal bleeding, lasting bowel changes, unexplained anemia or weight loss, or ongoing belly pain need a medical visit. Don’t wait for your screening birthday, and don’t let a negative stool test stand in for that visit.
Source: CDC symptom guidance
For ages 76–85, screening is decided individually, based on health, prior screening and preferences. Major guidelines advise stopping routine screening after 85. USPSTF · ACS
The cancer trends
The age shift is real.
The American Cancer Society’s 2026 analysis, by age group. [1]
| Age | Average yearly change, 2013–2022 | Cases per 100,000 people per year, 2018–2022 |
|---|---|---|
| 20–49 | +3.0% Increased | 13.1 |
| 50–64 | +0.4% Increased | 68.0 |
| 65+ | −2.5% Declined | 153.1 |
ACS 2026, Tables 2–3 (age-adjusted; appendix cancers excluded). Population rates, not personal predictions.
A 3% yearly rise is not a 3% chance of cancer. Older adults still have higher rates overall.
Diagnoses before age 50 occur at ages 45–49, the group already eligible for routine screening. [1]
Colorectal cancer now ranks first among causes of cancer death in U.S. adults under 50. [1]
Explore birth-cohort findings, denominators, and limitations
Before cancer
Precancer is not waiting for retirement.
What first screening colonoscopies found at Kaiser Permanente Northern California, 2021–2024. [2]
| Finding | Ages 45–49 (4,380 people) | Ages 50–54 (7,651 people) |
|---|---|---|
| Any adenoma | 1,551 (35.4%) | 3,121 (40.8%) |
| Advanced adenoma | 165 (3.8%) | 314 (4.1%) |
| Advanced serrated lesion | 65 (1.5%) | 137 (1.8%) |
| Colorectal cancer | 3 (0.1%) | 9 (0.1%) |
Average-risk screening exams only. Categories overlap, so percentages don’t add up. One health system, not national rates.
Reading the data correctly
Two questions. Different evidence.
Colorectal cancer is rising in younger adults, and important precancer is already found at ages 45–49. Both are well supported. Whether advanced precancer itself is becoming more common is a separate question, with its own evidence.
What do studies of polyp trends actually show?
A U.S. pathology study examined 2,910,174 colonoscopies from 2008–2020. Serrated adenoma detection increased, while tubular adenoma detection decreased; precursor and cancer trends did not move uniformly together. Polyp trends study
This analysis did not establish a national trend for the specific combined endpoint “advanced precancer.” Changing recognition of lesions, the people referred for colonoscopy, and study definitions also matter when comparing detection rates.
Our interpretation: evidence of an important screening yield at age 45 is sufficient to explain why screening matters now. It should not be relabeled as proof of an increase over time.
Could more screening explain some of the recent increase in diagnoses?
Yes. After screening eligibility expanded in 2021, a 2026 SEER analysis found particularly rapid growth in early-stage diagnoses at ages 45–49. Age and stage trends study
| Diagnoses | Annual change |
|---|---|
| All stages | +14.38% |
| Early stage | +32.14% |
| Late stage | +3.29% |
For comparison, all-stage diagnoses in this age group increased 1.31% annually during 2004–2019. The authors interpret the recent acceleration as suggesting increased detection after screening expansion.
Murphy et al. likewise identify increased screening as a likely contributor to the rise in diagnoses at ages 45–49. Their estimate covers a different period; the full review explains how the study periods and age groups differ.
Our interpretation: a short post-guideline trend cannot separate changing underlying risk from more testing or pandemic-related disruptions. Rising late-stage diagnoses merit attention, but do not by themselves establish the cause of the rise. These figures are not a measured effect of colonoscopy on future cancer outcomes.
Burus & Semprini, online August 25, 2026. Numerical findings verified against the primary abstract; full methods and stage definitions were not independently reviewed.
Why start on time?
The opportunity comes before symptoms.
Polyps and early cancer usually cause no symptoms. Waiting for bleeding or pain turns prevention into a search for a problem. The U.S. Preventive Services Task Force and the American Cancer Society both recommend starting at 45. USPSTF · ACS
Colonoscopy looks at the colon directly and removes precancerous growths in the same visit. That is why we favor a high-quality colonoscopy when you’re due and it’s right for you. NCI evidence
Check the sources
The numbers, with their context.
A focused evidence review, not a formal systematic review. Core evidence reviewed September 27, 2026; Murphy review added November 1, 2026.
All nine sources
- Siegel et al. · Colorectal cancer statistics, 2026 CA Cancer J Clin. 2026;76:e70067. Registry surveillance; Tables 2–3 and screening discussion. ACS one-page facts
- Lee et al. · Screening colonoscopy yields at ages 45–49 JAMA. 2025;334:449–452. doi:10.1001/jama.2025.7494. Table 2. Single-system observational cohort.
- U.S. Preventive Services Task Force · Screening recommendation 2021 final recommendation. Ages, intervals, options, benefit–harm assessment, and modeling context.
- American Cancer Society · 2026 guideline summary Reaffirms routine screening from age 45 for average-risk adults. Guidance on higher-risk histories
- Sonnenberg et al. · Trends of colonic neoplasia Dig Dis Sci. 2022;67:4702–4707. doi:10.1007/s10620-021-07358-8. Pathology-based observational analysis; 2008–2020. Abstract verified; not an estimate of national advanced-precancer incidence.
- Burus & Semprini · Age and stage trends after screening expansion Am J Prev Med. Online August 25, 2026. doi:10.1016/j.amepre.2026.108568. SEER analysis; abstract-level review. Authors report no competing interests.
- CDC · Symptoms of colorectal cancer Updated June 17, 2026. Symptoms and the importance of assessment.
- National Cancer Institute · Screening tests and polyps Mechanisms, precancer removal, risk factors, and test limitations. Current screening ages are sourced separately to the USPSTF and ACS.
- Murphy et al. · Colorectal Cancer among U.S. Adults, 2000–2023 NEJM Evid. 2026;5(11). Published October 27, 2026. doi:10.1056/EVIDpha2600217. SEER 21 registry surveillance; diagnoses through 2023. Full report reviewed November 1, 2026; supplementary tables and individual disclosure forms were not independently reviewed. Read our full interpretation and study context
Study disclosures and review limits
The ACS statistics authors are ACS employees, paid through ACS funds. ACS receives outside grants for other work; authors reported no conflicts.
Lee et al. disclose grants involving NCI, PCORI, Medial Research, and Freenome, plus a Geneoscopy advisory role then uncompensated. These author disclosures do not establish study sponsorship.
The polyp-trend and age/stage studies above were reviewed at abstract level; detailed funding information unavailable in those abstracts is not represented as “no funding.” None of these age-pattern or screening-yield studies directly compares colonoscopy with Cologuard for long-term prevention in 45–49-year-olds.
Murphy et al. report support in part from NIH and the Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research Ablon Scholars Program. Individual disclosure forms are provided separately by the journal and were not independently reviewed. The November 1 addition is a targeted review of this report; other review dates and limits remain as identified.
This independent campaign is not endorsed by the named research organizations. Individual decisions should account for your medical history, procedure risks, preferences, and access.
You don’t have to feel older to be due.
Make a screening plan you can complete, and keep.