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Turning 45? Time to Screen for Colon Cancer

A note on a laptop that says Schedule Colonoscopy

“Am I really that old?”

That was the first question 45-year-old Scott Larkin, a funeral director from Hamilton, N.J., asked after his primary care provider recommended a colonoscopy to screen for colorectal cancer.

But any hesitation quickly disappeared as he thought about two close friends, both in their 40s, who had recently been diagnosed with colon cancer.

“My one friend, who is younger than me, had colon cancer and it’s in remission now,” Larkin said. “But another friend who is a year older is facing a second go round with it.”

While the rate at which people are diagnosed with colorectal cancer in the United States has been dropping among people 50 and older, it is rising in younger age groups.

That is why in recent years, multiple medical societies, including the U.S. Preventive Services Task Force and the American Cancer Society, lowered the recommended age for when screenings should begin from 50 to 45 for people of average risk.

“There are few noticeable early signs of colorectal cancer, which is why screening is so important,” said Kevin Skole, MD, a gastroenterologist at the Center for Digestive Health at Penn Medicine Princeton Medical Center (PMC). “As with many types of cancer, early detection can help make colorectal cancer easier to treat and even prevent entirely.”

Third Most Common Cancer

Kevin Skole
Kevin Skole, MD

Colon cancer is the third most common cancer diagnosed in both men and women each year in the United States, excluding skin cancer, according to the American Society of Clinical Oncology (ASCO).

This year, ASCO estimates that 151,030 adults in the United States will be diagnosed with colorectal cancer. In addition, it is estimated that colorectal cancer will claim the lives of 52,580 men and women in the United States in 2022.

What’s more, while rates of colorectal cancer among people 50 and older dropped by about 2 percent each year from 2014 to 2018, rates among younger adults rose by 1.5 percent, according to ASCO.

“It’s unclear why there’s a rise in colorectal cancer rates among younger adults, but factors like obesity, lack of physical activity and smoking could all play a role,” Skole said. “There may also be a link to diet, particularly a diet high in processed meat and fat and low in fruits and vegetables.”

Additionally, according to the American Cancer Society, incidences of colorectal cancer continue to disproportionately affect members of the Black community. In fact, Black people are more likely to develop colon cancer than other groups. There are complex reasons for this disparity, including difference in risk factors and access to health care and health screenings.

Preventing Cancer Before It Starts

Most colorectal cancers start as polyps in the colon, or less commonly, the rectum. Over time, if left undetected, these growths can develop into cancer. However, through colonoscopy, physicians can identify and remove abnormal growths before they turn cancerous.

“When we perform a colonoscopy, we look for lumps and bumps that could be precancerous polyps and remove them right then and there,” Skole said.

Under current screening guidelines, screening for colon cancer should begin at age 45 for people of average risk, which means no personal or family history of colorectal cancer, no history of inflammatory bowel disease, no hereditary conditions associated with colorectal cancer and no radiation to the belly or pelvic area to treat a prior cancer.

While there are several different types of screening tests available, including stool-based tests that look for signs of cancer in a person’s stool, colonoscopy remains the only screening tool that can prevent cancer before it starts.

Cancer Prevention Success Story

When Larkin went for his colonoscopy, he didn’t expect the doctor to find anything.

“I figured let me just go and get it done and over with,” Larkin said. “The prep wasn’t that bad and Dr. Skole was excellent. He explained everything and how it was going to go.”

After the procedure, however, Larkin learned that Skole had found a 4-millimeter polyp and then removed it during the colonoscopy.

Skole explained that the polyp — a tubular adenoma — was small, but that it had the potential to become malignant if left alone.

“Tubular adenomas can progress through a series of cellular changes that can eventually lead to cancer,” Skole said. “If Scott had not gotten screened at 45 and waited until age 50, the polyp could have gotten larger and potentially developed into cancer, making his case more complicated. This is a cancer prevention success story.”

Skole advised Larkin to return for another screening in five years rather than 10, which is the normal recommendation for screening colonoscopy if no polyps are found.

“I guess I was a little surprised,” Larkin said. “Had I waited until I was 50, who knows. It could have been a different outcome.”

Don’t Delay

The Center for Digestive Health at PMC offers the Direct Access Colonoscopy program, which helps speed the scheduling of routine screening colonoscopies. Patients who meet certain criteria can schedule a procedure without first having an office visit with a gastroenterologist. Similar programs are available at hospitals throughout Penn Medicine.

For people who are delaying a screening colonoscopy, Larkin has this advice: “There really shouldn’t be any hesitation. Go get yourself screened. It could be lifesaving.”


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