Screening colonoscopy is often performed on patients who are younger or older than the ages specified in national guidelines (1-3), or at shorter intervals than recommended. Non-indicated use of the procedure is considered “low value care” or overuse (4-7). When screening colonoscopy is performed in accordance with guidelines, the potential benefits of this procedure exceed the risk of harm. Conversely, when not indicated, the risk of harm generally outweighs the potential benefits. Harms include rare but serious complications such as bowel perforation and gastrointestinal bleeding as well as infection, cardiovascular events, and death (8, 9).