How Often Should You Get a Colonoscopy and When Should You Start? (Because, Yes, Women Should Be Screened Regularly)

You know that you should book a mammogram every two years and a dental cleaning every year, but what about the rest of your body? A colonoscopy is a routine medical procedure that could save your life, but if you think that you don’t have to worry about getting one until you’re 50 then think again (hint: new guidelines came out recently and you should be booking one years before that). And how often should you get a colonoscopy, anyway? Read on for everything you need to know about this screening test, courtesy of a gastroenterologist.

Meet the Expert:

• Marianne T. Ritchie, MD is a practicing gastroenterologist with Jefferson University Hospital and host of Your Radio Doctor®. Dr. Ritchie, a leading advocate for over thirty years, also developed the PINK PLUS triple cancer screening program for women and launched the BLUE LIGHTS CAMPAIGN for Colon Cancer Awareness.

You probably know that a colonoscopy is a procedure that takes place, er, below the belt…but what goes in exactly and why? Dr. Ritchie tells us that the procedure is performed using a thin and flexible tube with a bright light, which allows the doctor to look directly at the lining of the large intestine and check for precancerous polyps and abnormalities that might indicate early colorectal cancer (CRC). Colonoscopies are, in fact, the most accurate exam for detecting and preventing CRC, and they save quite a lot of lives.

Per Dr. Ritchie, colonoscopies are performed as part of routine screening for colorectal cancer beginning at age 45 in individuals of average risk; they can also be performed for diagnostic purposes in individuals of any age who present with new symptoms such as abdominal pain, rectal bleeding, unexpected weight loss and change in bowel habits.

You might have thought 50 was the magic number when it comes to getting your first colonoscopy, and you would have been right a couple of years ago. However, the starting age was decreased to 45 years in 2021 due to a rise in colorectal cancer cases among younger patients. (Note: Data indicates that African Americans are at a 20 percent higher risk of developing colorectal cancer and 40 percent more likely to die from it, with cases often beginning at a younger age.)

It’s important to emphasize, though, that 45 is the starting age for folks at an average risk, but “a patient should begin before age 40 if they have a family history of CRC or colon polyps, or if they have other conditions that increase their risk such as inflammatory bowel disease,” says Dr. Ritchie. You should discuss your medical history with your doctor to determine the appropriate age to begin CRC screening but, in general, the expert recommends the following guidelines:

• If you have one first degree relative (parent, sibling, child) with CRC under the age of 60 then you should begin screening at age 40.
• If you have two or more first degree relatives with CRC of any age then begin screening at age 40 (possibly younger).
• If the first degree relative is under age 50 then subtract 10 years (so if your parent was diagnosed at 48, your screening would begin at age 38).
• There are also specific guidelines for screening patients with inherited familial cancer syndromes with multiple family members affected.

Once you’ve determined the age at which you should get your first colonoscopy and you’ve undergone the screening, you might wonder when you’ll have to tango with that little lighted tube again. There’s no one-size-fits-all answer for this one either, as the time for a repeat colonoscopy depends on what is found during your exam. “If you have polyps, your next examination will depend on the number, size and pathology report,” explains Dr. Ritchie. Individuals who have no polyps, no family history and no new symptoms can wait ten years before returning for a repeat colonoscopy, and folks with a family history, as outlined above, may be advised to return every five years, regardless of the outcome of their exam. Of course, if you develop any new symptoms during this time period, you should inform your doctor immediately and get checked to rule out the possibility that CRC or some other condition has developed.

Now you know the basics of the procedure, but it’s worth noting that you can’t just stroll into the doctor’s office for your colonoscopy without first doing a little prep. Although not as bad as it was when the colonoscopy first came on the scene in the 80s, Dr. Ritchie concedes that colonoscopy prep is still a bit of a commitment for patients.

For starters, you will be asked to drink a full liter of a special and rather unpleasant laxative solution provided by your doctor, followed by a liter of something more palatable, such as juice or Gatorade…and then repeat the process a few hours later. (This is done to prep your bowels for the procedure, and is most effective when the second half of liquid is consumed four to five hours before your scheduled appointment.) On this day, you will be consuming nothing but the aforementioned liquids, and the laxative solution may very well cause some discomfort.

On the bright side, you will be completely asleep (i.e., under anesthesia) for the procedure itself, and Dr. Ritchie reports that most patients are pleasantly surprised by how easy and painless it is. In other words, if your time for a colonoscopy has come, you really have nothing to fear.