For decades, the standard recommendation was simple: healthy adults with average colon cancer risk should get their first colonoscopy at age 50.
Then in 2021, the U.S. Preventive Services Task Force (USPSTF) officially lowered the starting age to 45 for adults at average risk. The American Cancer Society had actually made the same recommendation back in 2018. The driving force behind the change? A troubling rise in colorectal cancer diagnoses among people under 50 — a trend doctors and researchers have been tracking for years.
An estimated 19 million more Americans are now eligible for earlier screening than they were just a few years ago. If you’re between 45 and 49 and haven’t scheduled a colonoscopy, you’re not “ahead of schedule” — you’re right on time.
No single cause explains the increase in younger patients, though researchers point to factors including diet, obesity, sedentary lifestyles, and changes in gut microbiome health. Whatever the cause, the result is clear: waiting until 50 was leaving a window open.
The earlier age-45 recommendation is specifically for average-risk individuals — meaning no personal or family history of colon cancer or polyps, no inflammatory bowel disease, and no known genetic syndromes like Lynch syndrome or familial adenomatous polyposis (FAP). starting even earlier.
What to Expect During a Colonoscopy
For many people, anxiety about the procedure itself is what causes them to delay. Here’s the reality: a colonoscopy is typically well-tolerated, takes about 30 to 45 minutes; and the preps have improved.
What About Other Screening Options?
Colonoscopy is the gold standard for colorectal cancer screening. Stool-based tests like Cologuard (a DNA stool test) or the FIT (fecal immunochemical test) are much less reliable, especially for finding earlier lesions. There are a lot of false positives and negatives. More recent blood tests such as Shield tests also suffer from very poor sensitivity and specificity.
Reasons People Put Off Their Colonoscopy (And Why They Shouldn’t)
Colon cancer is one of the most preventable cancers — yet it remains the second leading cause of cancer death in the United States. A big part of the reason is avoidance. Here are the most common reasons people delay.
- “I feel fine — I don’t have any symptoms.” This is actually the most dangerous reason to delay. Colon cancer and precancerous polyps typically cause no symptoms in their early stages. By the time symptoms appear — rectal bleeding, changes in bowel habits, unexplained weight loss — the disease may already be more advanced. Screening is designed specifically to catch problems before symptoms develop.
- “I’m afraid of the prep”. Preparing for the colonoscopy is NOT as bad as they say. Most people begin the preparation when they get home from work, in the late afternoon or early evening, the day before the procedure. My staff will go over the prep and get you through it.
3. “I don’t have time to take a day off.” The procedure itself takes under an hour, and most people feel back to normal by the afternoon. You’ll need one day off — one — to potentially prevent cancer. That’s an easy trade.
4. “I’m scared of what they might find.” This fear is real and completely understandable. But consider the alternative: not knowing. Polyps, which are found very frequently, can usually be removed easily, thus preventing colon cancer. Colon cancer caught at stage I has a survival rate above 90%. The earlier a problem is found, the more options you have.
Schedule Your Colonoscopy with Dr. Braunstein in Farmingdale, NY
Dr. Michael Braunstein is a board-certified gastroenterologist with over 25 years of experience serving patients across Long Island. As a solo practitioner, Dr. Braunstein personally performs every colonoscopy — meaning you’ll see the same doctor for your consultation and your procedure, every time.
Dr. Braunstein’s office is here to help.
📞 Call us at 631-226-6717 🗓 Or request an appointment online
