When do I need my first colonoscopy?

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The current guideline: colorectal cancer screening starts at 45 for average-risk adults, moved down from 50 as cases rose in younger people, per NCI's screening guidance. Colonoscopy is the gold-standard option: it both finds and removes precancerous polyps in the same procedure, and a clean result buys ten years before the next one. The earlier-than-45 triggers: a first-degree relative with colorectal cancer or advanced polyps - screening starts at 40 or ten years before the relative's diagnosis age, whichever comes first; inflammatory bowel disease; certain inherited syndromes; and symptoms - rectal bleeding, a lasting change in bowel habits, unexplained anemia or weight loss - which are diagnostic-scope triggers at any age, not screening questions.

The repeat schedule: every 10 years after a clean colonoscopy at average risk, 5 years with small low-risk polyps, 3 years with larger or advanced ones.

If the scope itself is the barrier: stool-based options exist - FIT yearly and Cologuard every three years - with the standing rule that a positive stool test must be followed by a colonoscopy anyway. They are good screening for people who will do them; the best test is the one that actually happens. After 75, the decision becomes individual, based on health and prior screening history.

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