Screenings if you have IBD

Why screening changes

The American Cancer Society says IBD, including ulcerative colitis and Crohn's disease, increases the risk of colorectal cancer, and that people with IBD may need to start screening younger and be screened more often. It notes that IBD is different from irritable bowel syndrome (IBS), which does not appear to increase colorectal cancer risk. (ACS, risk factors)

MedlinePlus says the risk for colon cancer increases in each decade after ulcerative colitis is diagnosed, (MedlinePlus, ulcerative colitis) and that Crohn disease brings more risk for small bowel and colon cancer. (MedlinePlus, Crohn disease)

The USPSTF colorectal screening recommendation (ages 45 to 75) is for adults at average risk, which it defines as having no prior diagnosis of colorectal cancer, adenomatous polyps or inflammatory bowel disease, among other things. (USPSTF, 2021) So its schedule does not apply to people with IBD.

Surveillance colonoscopy

Who is offered it

NICE offers colonoscopic surveillance to people with IBD whose symptoms started 10 years ago and who have either ulcerative colitis (but not proctitis alone) or Crohn's colitis involving more than one segment of colon. (NICE CG118)

The British Society of Gastroenterology (BSG) suggests that people with IBD affecting the colon or rectum be risk assessed for surveillance. It says people with Crohn's disease not involving the colon above the rectum, isolated small bowel disease, or ulcerative colitis confirmed as confined to the rectum should not be offered surveillance, and should take part in the screening programmes offered to the general population. (BSG, 2025)

When it starts

American Cancer Society: colonoscopies (not any other type of test) starting at least 8 years after IBD is diagnosed. (ACS, guideline)
BSG: a baseline colonoscopy 8 years after symptoms began, to find risk factors; people with primary sclerosing cholangitis (PSC), which the BSG describes as a rare condition that causes inflammation of the bile ducts and can eventually damage the liver, are offered surveillance from the time of diagnosis. (BSG, 2025)
NICE: from 10 years after symptoms started, beginning with a baseline colonoscopy to set the risk group. (NICE CG118)
MedlinePlus: a colonoscopy is often recommended if Crohn disease has involved the colon for 8 or more years. (MedlinePlus, Crohn disease)

How often it repeats

The American Cancer Society says follow-up colonoscopies should be done every 1 to 3 years, depending on the person's risk factors for colorectal cancer and the findings on the previous colonoscopy. (ACS, guideline)

NICE sets the interval from the risk found at the last complete colonoscopy: (NICE CG118)

High risk, every year: extensive colitis with moderate or severe active inflammation, PSC (including after liver transplant), a colonic stricture or any grade of dysplasia (abnormal cells) in the past 5 years, or a parent, sibling or child with colorectal cancer under 50.
Intermediate risk, at 3 years: extensive colitis with mild active inflammation, post-inflammatory polyps, or a parent, sibling or child with colorectal cancer at 50 or over.
Low risk, at 5 years: extensive colitis that is quiet, or left-sided colitis.

The BSG suggests: (BSG, 2025)

Every year for people whose inflammation stays moderate despite treatment, or who have dysplasia, PSC or a colonic stricture.
Every 3 years for people whose inflammation stays mild, who have extensive disease or post-inflammatory polyps, or who have a parent, sibling or child with colorectal cancer.
A colonoscopy reassessment every 10 years, plus usual population screening for their age, for people with none of these risk factors.

The BSG says its 2010 guideline offered colonoscopy every 5 years to those at lowest risk, but that newer evidence suggests 3 years may be the appropriate interval, and that longer intervals are likely to be ineffective. (BSG, 2025) What a colonoscopy involves is on screening colonoscopy: what to expect, and follow-up after polyps is on colonoscopy after polyps.

When it may stop

NICE says that after each surveillance test, the benefits, limitations and risks of ongoing surveillance should be discussed, and any decision to stop should rest on the likely benefit for the person, their preferences and any other health conditions. (NICE CG118) The BSG suggests a discussion at age 75 before surveillance continues. (BSG, 2025)

Bone health

NICE lists Crohn's disease and other inflammatory bowel diseases among the factors associated with a higher risk of fragility fracture, which it describes as a fracture typically caused by a low-impact injury that would not normally cause one, such as a fall from standing height. (NICE NG259, terms) It says to consider assessing fracture risk in people aged 50 to 74, and in women under 65 who have been through menopause, who have such a factor. It says to assess fracture risk in everyone aged 50 and over, and women who have been through menopause, who currently or frequently use systemic glucocorticoids. (NICE NG259)

For children and young people, NICE says not to routinely monitor bone mineral density in Crohn's disease, but to consider it when there are risk factors such as a low body mass index, a fracture from minor injury, or continued or repeated glucocorticoid use. (NICE NG129) For ulcerative colitis, it says to consider monitoring bone health during chronic active disease, after systemic corticosteroids, or after recurrent active disease. (NICE NG130) See how often to have a bone density test and bone density test results.

Anal cancer risk

The BSG says long-lasting perianal fistulising Crohn's disease increases anal cancer risk, and lists a weakened immune system from disease or treatment among the established risk factors. It says the UK has no national anal cancer screening programme, and that there are no data to suggest regular anal smears would lower anal cancer risk. (BSG, 2025) MedlinePlus describes fistulas as abnormal connections between the intestines and another area of the body. (MedlinePlus, Crohn disease) See anal cancer screening.

When to contact a provider

MedlinePlus, Crohn disease, when to contact a medical professional. Contact your provider if you: (MedlinePlus, Crohn disease)

Have very bad abdominal pain
Cannot control your diarrhea with diet changes and medicines
Have lost weight, or your child with Crohn disease is not gaining weight
Have rectal bleeding, drainage, or sores
Have a fever that lasts for more than 2 or 3 days, or a fever higher than 100.4°F (38°C) without an illness
Have nausea and vomiting that lasts for more than a day
Have skin sores that do not heal
Have joint pain that prevents you from doing your everyday activities
Have side effects from medicines you are taking for your condition

MedlinePlus, ulcerative colitis, when to contact a medical professional. Contact your provider if: (MedlinePlus, ulcerative colitis)

You develop ongoing abdominal pain, new or increased bleeding, fever that does not go away, or other symptoms of ulcerative colitis
You have ulcerative colitis and your symptoms worsen or do not improve with treatment
You develop new symptoms

Where they differ:

When surveillance starts. The American Cancer Society counts at least 8 years from diagnosis, (ACS, guideline) the BSG 8 years from the start of symptoms (or from diagnosis with PSC), (BSG, 2025) and NICE 10 years from the start of symptoms. (NICE CG118)
Lowest-risk interval. NICE offers colonoscopy at 5 years to its low-risk group, (NICE CG118) the American Cancer Society says every 1 to 3 years, (ACS, guideline) and the BSG says intervals longer than 3 years are likely to be ineffective for surveillance, with a 10-year reassessment plus population screening for people close to population risk. (BSG, 2025)
Family history. NICE puts a parent, sibling or child with colorectal cancer under 50 in its yearly group and at 50 or over in its 3-year group, (NICE CG118) while the BSG suggests every 3 years for either age unless other risk factors apply. (BSG, 2025)
Average-risk schedules. The USPSTF schedule from 45 to 75 does not cover people with IBD. (USPSTF, 2021)

Your doctor decides what your result means for you.

Questions people ask

Does the usual colorectal screening schedule apply if I have IBD?

No. The USPSTF recommendation is for adults at average risk, which it defines as having no prior diagnosis of inflammatory bowel disease, among other things. The American Cancer Society puts people with Crohn's disease or ulcerative colitis in its high-risk group. (USPSTF, 2021) (ACS, guideline)

When does surveillance colonoscopy start with IBD?

The American Cancer Society says at least 8 years after IBD is diagnosed. The BSG suggests a risk assessment 8 years after symptoms began, or from diagnosis for people who also have primary sclerosing cholangitis (PSC). NICE says 10 years after symptoms started. (ACS, guideline) (BSG, 2025) (NICE CG118)

How often is colonoscopy repeated with IBD?

The American Cancer Society says every 1 to 3 years, depending on risk factors and the last colonoscopy. NICE offers it at 1, 3 or 5 years by risk group. The BSG suggests every year or every 3 years, or a reassessment every 10 years with usual population screening for people close to population risk. (ACS, guideline) (NICE CG118) (BSG, 2025)

Does everyone with IBD need surveillance colonoscopy?

No. NICE offers it to people with ulcerative colitis (but not proctitis alone) or Crohn's colitis involving more than one segment of colon. The BSG says people with Crohn's disease that does not involve the colon above the rectum, isolated small bowel disease, or ulcerative colitis confined to the rectum should join general population screening instead. (NICE CG118) (BSG, 2025)

Does IBD affect bone density checks?

NICE lists Crohn's disease and other inflammatory bowel diseases among the factors that can raise fracture risk, and says to consider assessing fracture risk in people aged 50 to 74, and women under 65 who have been through menopause, who have such a factor. (NICE NG259)