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Average-risk adults should be screened for colorectal cancer starting at age 50 years, and high-risk adults at age 40 years or 10 years younger than the age at diagnosis of the youngest affected relative, according to a new guidance statement from the American College of Physicians (ACP) (Ann Intern Med. 2012;156:378-386).

The new document calls for clinicians to perform individualized risk assessments for colorectal cancer in all adults. Risk factors include increasing age; race (African Americans have the highest incidence and mortality rates for colorectal cancer in the United States); personal history of polyps, inflammatory bowel disease, or colorectal cancer; and family history of colorectal cancer.

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Once a patient is assessed, the clinician should follow the above-stated age guidelines for screening initiation. The ACP also advises discontinuing screening in adults older than 75 years and in adults with a life expectancy of less than 10 years.

Average-risk patients should be screened for colorectal cancer using a stool-based test, flexible sigmoidoscopy, or optical colonoscopy, and high-risk patients should undergo optical colonoscopy. However, counsels the ACP, tests should be selected based on the benefits and harms as well as availability, and also should be based on patient preferences.

When choosing a stool-based test, clinicians may not want to use fecal DNA tests based on a recent white paper issued by the Agency for Healthcare Research and Quality (AHRQ). After conducting a review, the agency determined that insufficient evidence exists to support using fecal DNA tests to screen adults at average risk of colorectal cancer. AHRQ calls for further research on the effectiveness of fecal DNA testing compared with other stool-based screening tests (AHRQ Publication No. 12-EHC022-EF). ONA