5 Signs You Should Get A Colonoscopy Before You Turn 45

It’s been frequently reported that colorectal cancer rates are increasing in young people in the United States.

In fact, according to the American Cancer Society, cases of colorectal cancer in people 55 and under have increased from 11% in 1995 to 20% in 2019 ― and since the late 1990s, colorectal cancer has moved up from the fourth cause of cancer death in people under 50 to the first cause of cancer death in men and second in women.

But when it comes to colorectal cancer detection, the Centers for Disease Control and Prevention says that only adults between the ages of 45 and 75 should be screened. This can be done via several different methods, but the Food and Drug Administration calls a colonoscopy the “gold standard for screening.”

Given the rising rates of colorectal cancer instances in younger adults, it’s safe to say that many people should not wait until 45 for their first colonoscopy. Experts say certain symptoms, personal health history and family health history can be reason enough to get screened before then. Here’s when you may want to consider it:

“What would make me nervous or worried is someone who’s bleeding on and off seeing blood in the stool,” said Dr. Carole Macaron, a gastroenterologist at Cleveland Clinic.

According to the American Cancer Society, blood in your stool is not always indicative of cancer ― but it can be a sign.

“The passage of blood, even if it’s just blood on the toilet paper and you think and it probably is secondary to hemorrhoids, you should get that checked out,” said Dr. Reid Ness, an associate professor of medicine in the gastroenterology, hepatology and nutrition department at Vanderbilt Health in Nashville, Tennessee. Whether it’s bright red or dark brown blood, or causing black, tarry stool, you should tell your physician, Ness said.

Any change in bowel habits and appearance ― whether it’s going more or less often than you usually do, or a difference in the shape or consistency of your stool ― can be a red flag, according to Dr. Jeffrey Dueker, a gastroenterologist at UPMC and an associate professor of gastroenterology at the University of Pittsburgh School of Medicine. Ness noted that persistent constipation is another warning sign.

It’s especially worth bringing up bowel changes to your doctor if they last for more than a few days, according to the American Cancer Society. Ness said that at the very least, you should get a physical examination, and your doctor may recommend a colonoscopy.

According to Macaron, unexplained abdominal pain can also be cause for concern. This can range from cramps to general discomfort to full-on pain, per the University of Texas’ MD Anderson Cancer Center.

It’s important to know that the discomfort will vary depending on the person’s perception and pain tolerance.

If you lose weight without trying, that’s likewise a sign you should see your doctor and ask about a potential colonoscopy, Dueker noted.

People who have a parent, sibling or child with a history of colorectal cancer should be screened before the age of 45, according to Macaron.

“If you have one first-degree relative with colorectal cancer, based on a meta-analysis of multiple studies, your risk is about two times higher,” she said. “If that first-degree relative had their colon cancer at… 50 or younger, your risk is up to three times higher.”

If you have a first-degree relative with colorectal cancer, the recommendation is that you get your first colonoscopy at age 40, or 10 years before the age your family member was when they were diagnosed ― whichever comes first, Macaron explained. For example, if your mom was diagnosed with colon cancer at 44, you should get your first colonoscopy at 34. If your parents or siblings had large polyps, you should also be screened at 40, Ness said.

“During a colonoscopy, if we see a polyp, and we believe it to be the precancerous kind, which the vast majority are, we will remove those polyps at the colonoscopy,” Dueker said. “And in doing so, we are reducing the colorectal cancer risk going forward.”

Polyps aren’t often a frequent topic of discussion among family members, Ness said, so it’s important to be open about your health with your loved ones and to inform them about any procedures or findings.

While extremely common in young women, iron deficiency anemia can be a red flag in some — but not all — cases, Ness said. Menstruation can be the cause of iron deficiency anemia, but if your OB-GYN thinks there is cause for concern, or you’re nervous, get in touch with your doctor and inquire about a colonoscopy. Iron deficiency in males is always cause for concern, and a colonoscopy should be discussed with your doctor, Ness said.

If you have inflammatory bowel disease, you’ll want to get a colonoscopy before age 45, as well.

“Any sort of inflammation that involves the colon can put yourself at risk for precancerous changes called dysplasia, or colon cancer,” Dueker said. “There are other medical conditions as well. For example, if someone has had radiation treatment to the pelvic or abdominal area for other reasons, that also could increase your risk of colon cancer.”

If you have a personal history of colorectal cancer, you’re at heightened risk, too. Additionally, if you carry an alteration in one of the cancer genes, you should also start colorectal cancer surveillance early, Macaron said.

“People at higher risk [due to] family history or symptoms should have [a] colonoscopy,” Ness said. But if you’re 45 or older with no risk factors, and you’re avoiding getting screened because of fear of colonoscopies or issues with the prep, you do have other screening options, including fecal tests and CT scans.

“The most important thing is to get your screening if you’re in the screening age,” Ness said. “The biggest problem right now… is that we’re only at about 70% of the at-risk population screened, which means that 30% isn’t. And we’ve shown that we can decrease colorectal cancer mortality by at least 50% with active screening.”

And as noted above, colorectal cancer rates in young people are rising. Just because the guidelines say you can wait until you’re 45 to get screened for colorectal cancer, that doesn’t mean you should.

“Something has happened, it’s clear that there’s an upward trend … The curve goes up since the 1950s,” Macaron explained. “And when you look at numbers, those who were born in the 1990s have twice as high the risk of colon cancer, four times as high the risk of rectal cancer compared to those who were born in the 1950s.”

So, it’s important to take family history, personal health history and symptoms seriously. If you have any concerns, no matter how small they might seem, don’t be afraid to ask your doctor about a colonoscopy.

As you wait for your appointment, though, it’s important not to panic. The symptoms highlighted above don’t definitively mean you have colon cancer, but they “could be a sign that something is going on that would warrant a colonoscopy, and one of those things could be that colon cancer is the cause of that symptom change,” Dueker said.

Being on top of your health is never a bad idea. At minimum, it can help you get in control of any bothersome symptoms. And in some cases, it just might save your life.

“Colorectal cancer is preventable,” Ness said, “so please avail yourself of the available testing to find it early and to remove the polyps that become cancer before they have a chance to do so.”