At what age can you stop getting colonoscopies? What each guideline says

This guide compares four US bodies that publish colorectal cancer screening guidance for adults at average risk, and on stopping they agree more than they differ. They do not define average risk identically; our colorectal cancer screening page sets out how USPSTF, ACS and ACP each draw that line. All four treat 75 as the point where routine screening ends. Three of them then make ages 76 to 85 an individual decision; the fourth, the American College of Physicians (ACP), draws the line at 75.

The Multi-Society Task Force speaks for the American College of Gastroenterology, the American Gastroenterological Association and the American Society for Gastrointestinal Endoscopy. Its 2022 update kept the stopping ages from its 2017 statement unchanged "given a lack of new evidence to alter current practice."

ACP words its rule two ways. Its August 1, 2023 announcement says "ACP suggests that clinicians" stop. The guidance statement's own abstract says: "Clinicians should stop screening for colorectal cancer in asymptomatic average-risk adults older than 75 years or in asymptomatic average-risk adults with a life expectancy of 10 years or less." The "or" matters: under ACP, a short life expectancy ends screening at any age, not only after 75. ACS uses the same yardstick from the other side: people in good health with a life expectancy of more than 10 years should continue through 75.

A grade C is not a recommendation against screening. The USPSTF recommends that clinicians "selectively offer" it from 76 to 85, because "the net benefit of screening all persons in this age group is small," and it names what should decide each case: "the patient's overall health, prior screening history, and preferences."

Its assessment is narrower than the headline grade. The USPSTF concludes "with moderate certainty that screening for colorectal cancer in adults aged 76 to 85 years who have been previously screened has small net benefit," and the next sentence reads: "Adults who have never been screened for colorectal cancer are more likely to benefit."

The reasons run in both directions. Modeling studies "estimate that generally, few additional life-years are gained when screening is extended past age 75 years among average-risk adults who have previously received adequate screening." Meanwhile harms rise: across 23 studies that reported harms by age, "Overall findings indicated increasing risk of bleeding and perforation with increasing age." The USPSTF gives no separate grade for 86 and older; its clinical considerations say evidence there "is lacking, and competing causes of mortality likely preclude any survival benefit that would outweigh the harms of screening."

García-Albéniz and colleagues wrote in the Annals of Internal Medicine (2017) that no randomized trial of screening colonoscopy had been completed and that ongoing trials excluded people 75 or older. In its place they ran an emulated trial, built from Medicare data on 1,355,692 beneficiaries aged 70 to 79 at average risk who had not had a diagnostic or surveillance colonoscopy in the previous 5 years. It compared screening colonoscopy with no screening. We read the abstract.

From 70 to 74, screening colonoscopy was estimated to lower the 8-year risk of a colorectal cancer diagnosis by 0.42 percentage points, about 4 fewer cancers per 1,000 people screened (our arithmetic), against 5.6 extra adverse events per 1,000. From 75 to 79 the estimate shrank to 0.14 points, about 1.4 per 1,000 (our arithmetic), with a confidence interval that crosses zero, while the excess adverse events nearly doubled to 10.3 per 1,000. A cancer prevented and an adverse event are not equal weights, and no table can make that call for you.

The authors concluded the risk of adverse events "was low but greater among older persons." The study counted cancer diagnoses, not deaths: "CRC-specific mortality was not available."

Every body that individualizes the decision names prior screening history, and modeling shows why. The Multi-Society Task Force points to "considerable lag time in the progression of a precancerous polyp to malignancy and CRC-related death"; on our reading, a clean earlier colonoscopy leaves a late one little to find. A 2014 cost-effectiveness study by van Hees and colleagues (Annals of Internal Medicine) modeled a one-time screen in unscreened adults aged 76 to 90 at average risk. We read the abstract.

The authors' conclusion: "In unscreened elderly persons CRC screening should be considered well beyond age 75 years. A colonoscopy is indicated at most ages." Their results were "most sensitive to assuming a lower willingness to pay per quality-adjusted life-year gained," so on our reading these ages are an upper edge rather than a target.

The Multi-Society Task Force's 2022 update summarizes a 2021 simulation built on Canadian data and FIT only, in which "women without a history of screening and no comorbidities benefitted from annual FIT screening until age 90, whereas unscreened men with or without comorbidities benefited from annual FIT screening until age 88. Conversely, screening was not beneficial beyond age 66 in men or women with severe comorbidities." The Task Force notes the study "did not evaluate an optimal age to stop screening with colonoscopy," and, "Given the paucity of new data," kept 76 to 85 an individual decision.

ACS and ACP both tie the decision to life expectancy, and a 2014 modeling study cited in the USPSTF statement makes the trade explicit. Lansdorp-Vogelaar and colleagues used seven simulation models, covering mammography, PSA testing and FIT for colorectal cancer, to ask at what age a person in a given state of health reaches the same balance of harms and benefits as a person of average health screened at 74. We read the abstract. The answer was 76 for people with no comorbid conditions, 74 with mild, 72 with moderate and 66 with severe, and those ages were "consistent across models and cancer sites." The authors note one limitation: in the models, comorbid conditions "influenced only life expectancy," so on our reading any extra risk a test carries for a sicker person is not counted.

On our reading, that is the useful frame for a conversation with a clinician: the question is health, and age is a rough proxy for it.

Everything above is screening for people at average risk. Once a colonoscopy has found and removed adenomas, later colonoscopies are surveillance, and their timing depends on what was found. ACS states that most people who have had certain types of polyps removed "will need to get a colonoscopy again after 3 years," with the exact interval depending on "the type, size, and number of polyps."

The Multi-Society Task Force's 2020 surveillance guideline sets no age to stop. On older adults, it says that "more research is needed to determine whether the potential cancer prevention and early detection benefits of surveillance outweigh immediate procedure-related risks for individuals older than age 75 years, or with multiple comorbidities." On our reading, that leaves the decision to the gastroenterologist who knows what was removed.

The age limits also apply only to people without symptoms. The USPSTF's recommendation covers adults "who do not have signs or symptoms of colorectal cancer"; symptoms at any age are a matter for your clinician, not for a screening schedule.

Medicare's rule for screening colonoscopy has no upper age. Medicare.gov lists Part B coverage once every 120 months if you are not at high risk, once every 24 months if you are, and you pay nothing for the screening if your provider accepts assignment; if a polyp is removed, you pay 15% of the Medicare-approved amount for the provider's services, and in a hospital outpatient setting or ambulatory surgical center you also pay the facility a 15% coinsurance. The regulation behind it, 42 CFR 410.37(g), sets those intervals and no age limit. Stool DNA testing is different: Medicare.gov lists eligibility for a multi-target stool DNA test as "between 45-85."

Medicare paying for a colonoscopy at 82 is a coverage fact, not a guideline.

One timing consequence follows from the 10-year interval (our inference): a normal screening colonoscopy at 66 makes the next one due at 76, inside the band where the decision is individual. If you are in your mid-60s and due, it is a reasonable moment to ask whether this one is likely to be your last.

Our colorectal cancer screening page carries each body's starting and stopping ages, quoted and dated at the row level, and your personal screening plan lists the screenings that apply at your age and sex, so the colonoscopy question can be raised alongside the rest at one visit. If a stool test is on the table past 75, see our comparison of Cologuard and colonoscopy.

Bring the facts the guidelines turn on: when your last screening was, which test, what it found, and how your health stands today. Other cancers answer the stopping question differently: see mammograms after 75 and when to stop lung cancer screening.