CRC incidence in the younger population (45-49 years) is increasing in Asia. Studies from Taiwan, Korea, Japan and Hong Kong have confirmed the change in epidemiology and is more prominent in males than females, and more in rectal cancer than colonic cancer (Sung et al. AM J Gastroenterol 2019). This is subsequently confirmed as a global phenomenon. (Lui et al. Cancer Epi Biomarker & Prev 2019). However, this could increase endoscopy burden and hence healthcare budget. The optimal way of including the young CRC in screening is to select the high risk younger generation e.g. family history, obesity, for the screening. On the other hand, age above 75 years should not be an absolute contraindication for CRC screening (Wolf CA Cancer J Clin 2018). Patient’s health condition, life expectancy and willing to cooperate for good bowel preparation should be taken into consideration.