2023 Colonoscopy Guidelines | July 2023 | Clinical Corner

July 15, 2023



Adults who are at average risk for colorectal cancer (CRC) used to start having regular colonoscopies when they turned 50. Now the timeline has changed. The American Cancer Society and The U.S. Preventive Services Task Force recommend that colorectal cancer screenings begin at age 45. This is due to the increased death rates from CRC with Colorectal cancer expected to cause about 52,550 deaths in 2023, according to the American Cancer Society1, with Black people almost twice as likely as other races to die from cancer of the colon and rectum.


People at increased or high risk of colorectal cancer might need to start colorectal cancer screening before age 45, be screened more often, and/or get specific tests. This includes people with:

  • A strong family history of colorectal cancer or certain types of polyps.
  • A personal history of colorectal cancer or certain types of polyps.
  • A personal history of inflammatory bowel disease (ulcerative colitis or Crohn’s disease).
  • A known family history of a hereditary colorectal cancer syndrome such as familial adenomatous polyposis (FAP) or Lynch syndrome.
  • A personal history of radiation to the abdomen (belly) or pelvic area to treat a prior cancer2.


For people ages 76 through 85, the decision to be screened should be based on a person’s preferences, life expectancy, overall health, and prior screening history.


People over 85 should no longer get colorectal cancer screening.



Stool-based tests

  • Highly sensitive fecal immunochemical test (FIT) every year.
  • Highly sensitive guaiac-based fecal occult blood test (gFOBT) every year.
  • Multi-targeted stool DNA test (mt-sDNA) every 3 years.

Visual (structural) exams of the colon and rectum

  • Colonoscopy every 10 years.
  • CT colonography (virtual colonoscopy) every 5 years.
  • Flexible sigmoidoscopy (FSIG) every 5 years.


The American College of Gastroenterology recommends colonoscopy or fecal immunochemical testing (FIT) as the primary CRC screening method because of cost and clinical effectiveness. Other two-step screening modalities are acceptable if patient preference increases screening3.



  1. https://www.uchicagomedicine.org
  2. https://www.cancer.org
  3. https://www.aafp.org