Blog Post

Why Is 45 the New 50?

No one wants colorectal cancer. But no one wants a colonoscopy, either. At least you don’t have to undergo that particular test until you turn 50.

But wait — the American Cancer Society just moved the goalposts and now recommends you get your colon checked five years earlier. The new guidelines make about 21 million Americans eligible (and possibly past due) for their first colonoscopy. If you’re one of them, we’ve got you covered. 

At Gateway Gastroenterology in Chesterfield, Missouri, our board-certified specialists and experienced team of medical professionals offer colorectal cancer screening for people 45 years and older — and younger. 

Deciding when to get your first colonoscopy depends on several issues, and the new age guideline is only one contributing factor. We can help you navigate the colonoscopy requirements and chart a course of exams that will detect, prevent, and resolve colorectal cancer.

Colon cancer screening vs. colonoscopy

Let’s start by defining terms. Colon cancer screening, often called colorectal cancer screening, is any test that checks for signs of cancer in your colon or rectum even before symptoms begin. Screening tests can save your life because they enable us to treat and eliminate colon cancer in its earliest stages.

Stool test

You can’t turn on your television or scroll through your social media feed without seeing an ad for an at-home stool test called Cologuard®. This test allows you to take a stool sample in the privacy of your home and mail it off to a lab. 

Unfortunately, the test is limited and often inaccurate. It only detects DNA markers in your stool and checks for the presence of blood. If the lab work is wrong, you can get a false-positive result, meaning the test shows you may have cancer when you really don’t.

On the other hand, at-home colon stool tests can deliver a false-negative, meaning it gives you a clean bill of health even though you have cancerous cells lurking within. Either way, you’ll need a colonoscopy to verify the results, so why not start with the test that works? 


When we perform a colonoscopy at Gateway Gastroenterology, we use the most advanced equipment and techniques to keep you comfortable. Using a long, slender tube fitted with a camera, we explore the inside of your colon and large intestine. We insert the tub through your anus and pump air through it to expand the environment, so we can get a good look.

If we see any polyps (small growths), we can snip them off and test them in a lab. Cologuard can’t do that. Most polyps are benign, but if we catch a cancerous one, you’ll be thankful you came in for a colonoscopy.

It takes about 15 minutes to reach the end of your large intestine and 15 more to retract it. We may repeat the path to ensure we see every inch of your intestine. 

Why the change from 50 to 45 for my first colonoscopy?

In 2021, the U.S. Preventive Services Task Force and the American Cancer Society made a new recommendation for colorectal cancer screening. They now suggest people at average risk should start getting screened at the age of 45 instead of 50 due to an increasing number of cases among young adults.

While the exact cause isn’t clear, there are several factors associated with colorectal cancer in younger folks, including:

  • Genetics
  • Environmental factors
  • Diet
  • Obesity
  • Excessive alcohol consumption
  • Smoking
  • Family history of colon cancer
  • Inflammatory bowel disease

Certain ethnic groups have a higher risk of developing colon cancer, such as Latinos, Blacks, and Native Americans. If you fall into one or more of the high-risk groups, you may need to come in for a colonoscopy even sooner. 

After your first colonoscopy, you can expect to return for another in about three years, unless we find something concerning or you have symptoms that warrant another test sooner. 

Your optimal colonoscopy schedule is unique to you and depends on personal factors. To find out when to schedule your first and subsequent colonoscopies, request an appointment at Gateway Gastroenterology today by calling our office or using our online booking tool.