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Colonoscopy Screening Guidelines: Who Should Get Tested and When

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Colorectal cancer is a prevalent and potentially deadly disease that affects millions of people worldwide. Fortunately, colonoscopy screening is a highly effective tool for early detection and prevention. However, knowing when and for whom this procedure is recommended is essential for reaping its benefits.

In this article, we will explore colonoscopy screening guidelines, including who should get tested and when, to reduce the burden of colorectal cancer.

Understanding Colonoscopy Screening

Colonoscopy screening is a medical procedure that allows for the visualization of the colon’s lining using a long, flexible tube with a camera at the end. It is the gold standard for detecting and preventing colorectal cancer, as it can identify precancerous polyps and early-stage cancers.

Here’s a closer look at colonoscopy screening guidelines to help you determine when and for whom this procedure is recommended.

The Importance of Early Detection

Colorectal cancer is the second leading cause of cancer-related deaths in the United States. Early detection is critical because it allows for more effective treatment, often resulting in better outcomes. Regular colonoscopy screening is a proven method for achieving early detection and reducing the burden of this disease.

Screening Recommendations by Age

The timing of your first colonoscopy largely depends on your age and risk factors. Here are the general screening recommendations by age:

Age 45 to 50

In the past, screening typically began at age 50 for individuals at average risk. However, in recent years, guidelines have shifted, and some organizations now recommend starting screening at age 45. This change is due to the rising incidence of colorectal cancer in younger age groups.

Age 50

For many years, age 50 was the standard starting point for colonoscopy screening. If you have no specific risk factors or symptoms, this is a suitable age to consider your first screening.

Age 75

For individuals aged 75 and older, the decision to continue colonoscopy screening should be made based on individual health status and life expectancy. Discuss this with your healthcare provider.

High-Risk Individuals and Early Screening

While the general population should consider screening starting at age 45-50, certain high-risk groups require earlier and more frequent colonoscopy screening. These groups include:

Family History

Individuals with a family history of colorectal cancer or polyps, particularly in first-degree relatives (parents, siblings, or children), should start colonoscopy screening earlier than the general population. The recommended age may be ten years earlier than the age at which the relative was diagnosed.

Personal History

If you have previously had colorectal cancer or adenomatous polyps (a type of polyp that can become cancerous), you will need to undergo regular colonoscopy screening starting shortly after the initial diagnosis.

Genetic Syndromes

Some hereditary genetic syndromes, like familial adenomatous polyposis (FAP) and Lynch syndrome, significantly increase the risk of colorectal cancer. Screening is generally recommended at a younger age and more frequently for individuals with these syndromes.

Interval Between Screenings

The frequency of colonoscopy screenings depends on several factors, including your initial findings and risk factors:

Normal Colonoscopy

If your first colonoscopy reveals no abnormalities, you may not need another colonoscopy for ten years, assuming you have no specific risk factors.

Small Polyps

In cases where small, low-risk polyps are removed during your colonoscopy, your gastroenterologist may recommend another colonoscopy in 5-10 years, depending on your individual health and family history.

High-Risk Findings

When significant polyps or other abnormalities are discovered during your initial colonoscopy, your healthcare provider may recommend more frequent screenings, typically every 3-5 years.

The Role of Other Screening Tests

While colonoscopy is considered the gold standard for colorectal cancer screening, other tests are available and may be suitable for some individuals. It’s essential to discuss these options with your healthcare provider. These tests include:

  • Fecal Occult Blood Test (FOBT). The FOBT is a non-invasive screening test that checks for hidden blood in the stool. If results are positive, it may warrant further investigation, which often includes a colonoscopy.
  • Sigmoidoscopy. Sigmoidoscopy is similar to colonoscopy but only examines the lower part of the colon. If this test is performed, it may be complemented by a full colonoscopy if abnormalities are detected.
  • Virtual Colonoscopy (CT Colonography). This imaging test provides a detailed view of the colon. If suspicious findings arise, a follow-up colonoscopy may be recommended for a more thorough examination.

Preventing Colorectal Cancer

Colorectal cancer is often preventable, and regular colonoscopy screening plays a vital role in achieving this goal. By identifying and removing precancerous polyps before they become malignant, individuals can significantly reduce their risk of developing colorectal cancer. Additionally, adopting a healthy lifestyle and dietary choices can contribute to prevention:

  • Dietary Choices. Consuming a diet rich in fiber, fruits, vegetables, and whole grains can lower your risk of colorectal cancer. Limiting red and processed meats is also advised.
  • Physical Activity. Regular physical activity can help maintain a healthy weight and reduce the risk of colorectal cancer.
  • Smoking Cessation. Quitting smoking is associated with a lower risk of developing colorectal cancer, among other health benefits.


Colonoscopy screening is a powerful tool in the fight against colorectal cancer. It’s essential to understand the guidelines for when and for whom this procedure is recommended.

While the general population should consider starting colonoscopy screening at age 45-50, high-risk individuals and those with family history or genetic syndromes may need to undergo screening at a younger age and more frequently.

Early detection and prevention of colorectal cancer can save lives and improve outcomes, and it’s vital to consult with your healthcare provider to determine the most suitable screening plan for your individual circumstances.

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