Scope and Target Population:
This guideline addresses appropriate screening methodology for colorectal cancer in patients 50 to 80 years of age and age 45 to 80 for African Americans.

Clinical Highlights and Recommendations:

• Screening criteria for this guideline includes:
  
• The patient must meet all four of the following criteria:
  - 50 to 80 years old or if African American 45 to 80 years old;
  - No personal history of polyps and/or colorectal cancer;
  - No family history of colorectal cancer in:
  
  • one first-order relative diagnosed before age 60 or
    
  • two first-order relatives diagnosed at any age
  - No family history of adenomatous polyps in:
  
  • One first-order relative diagnosed before age 60

(A single first-order relative diagnosed with colorectal cancer after age 60 may put the patient at a slightly increased risk and may warrant starting colon cancer screening at age 40. A single first-order relative with an adenomatous polyp diagnosed after age 60 may put the patient at a slightly increased risk and may also warrant starting colon cancer screening at age 40).

• Colorectal cancer screening is recommended for all patients 50 to 80 years of age, using one of the following methods based on joint decision making by patient and provider:
  - Flexible sigmoidoscopy every five years.
  - Annual FOBT.
  - Combination of flexible sigmoidoscopy every five years and annual FOBT.
  - Total colon evaluation as defined in the guideline.

Priority Aims:

1. Increase the percentage of people aged 50 to 80 who are up-to-date with colorectal screening.
   
2. Increase patient participation in screening for colorectal cancer.
   
3. Increase the percent of positive colorectal cancer screening tests that have follow-up tests.
   
4. Reduce wasteful, unproductive processes for colorectal cancer screening.

Additional Background:
The Colorectal Cancer Screening work group acknowledges the important role played by education and outreach efforts in helping to increase the number of risk-appropriate individuals who present themselves for colorectal cancer screening, thereby increasing the rate of early detection of this disease. However, its work must be seen within the larger context of all preventive health activities, and is viewed as no more or less important than other screening outreach and educational activities.