If you turned 45 recently and your doctor mentioned a colonoscopy, you heard right — and it is not a mistake or an over-call. In 2021 the U.S. Preventive Services Task Force formally lowered the recommended start age for colorectal cancer screening from 50 to 45 for average-risk adults, in response to rising rates of colon cancer in younger people (USPSTF). For Montgomery County adults, that change quietly moved up one of the most effective cancer screenings we have by five years.

What changed, and why it matters

Colorectal cancer is one of the few cancers we can often prevent, not just catch early — because screening can find and remove precancerous polyps before they ever become cancer. The Task Force gives screening adults 45–49 a Grade B recommendation and adults 50–75 a Grade A recommendation (USPSTF). Under the Affordable Care Act, Grade A and B preventive services are generally covered by insurance without cost-sharing — so for most insured patients, screening at 45 is a covered benefit.

Colorectal cancer screening start age lowered from 50 to 45 A timeline showing that average-risk colorectal cancer screening now begins at age 45 instead of the previous age 50. Start screening at 45, not 50 40 45 50 75 NEW: age 45 old start (50) Screen routinely 45 → 75
If you have a family history of colorectal cancer or symptoms, your doctor may start screening even earlier. Source: U.S. Preventive Services Task Force.

Your screening options

There is more than one right way to get screened, and the best test is the one you will actually complete:

  • Colonoscopy — the gold standard, done every 10 years for average risk. It both screens and removes polyps in one sitting, but requires bowel prep and sedation.
  • Stool-based tests (FIT or multi-target stool DNA) — done at home every 1–3 years depending on the test. Easy and noninvasive, but any positive result must be followed by a colonoscopy to count as complete screening.
  • CT colonography — an imaging alternative for select patients.

The decision is worth a conversation with a gastroenterologist or primary doctor about your risk and preferences. Locally, Dr. Ajay Bakhshi — Chair of Gastroenterology at Suburban and Holy Cross — is a credential-strong choice with a particular focus on colon cancer prevention and advanced endoscopy.

A doctor discussing results with a patient
The best screening test is the one you'll complete. A short conversation about your risk usually settles which option fits. (Image: Pexels)

If you’re uninsured in Montgomery County

Cost should not be the reason anyone skips this. Montgomery County’s Colorectal Cancer Screening program provides colonoscopy and follow-up care at no cost to eligible residents who are age 45 or older, uninsured or underinsured, with family income up to 250% of the federal poverty guidelines (Montgomery County DHHS). It is part of the statewide Maryland Colorectal Cancer Control Program run through local health departments (Maryland Department of Health).

Where to start

The bottom line: if you are 45 or older and have never been screened, you are due now — and in Maryland, there is a path to get it done regardless of insurance.

Sources & further reading