African American patients should begin screening for colorectal cancer (CRC) at age 45 years rather than age 50, according to recommendations from the American College of Gastroenterology (Am J Gastroenterol. 2009;104:739-750). Representing the organization’s first revisions since 2000, the CRC screening guidelines include the following key recommendations and changes:

  • Colorectal screening tests are now grouped into prevention tests and detection tests.
  • The preferred CRC prevention test is colonoscopy every 10 years beginning at age 50 years for non-African Americans, with the procedure performed by appropriately trained and skilled examiners. CT colonoscopy, also known as “virtual colonoscopy,” is not considered to be an equivalent screening strategy.
  • African Americans should begin CRC screening with colonoscopy at age 45 years because of the high incidence
  • of CRC and certain cancerous lesions in this population.
  • The preferred CRC detection test is annual fecal immunochemical testing.
  • Prevention tests are preferred over detection tests; prevention tests should be offered first.
  • “Split dosing” is now recommended to improve the effectiveness and tolerability of bowel preparation, with half the dose given on the day of the procedure rather than the entire dose being given the day before.
  • Colonoscopy patients should be permitted to ingest clear liquids until two hours prior to sedation; this new recommendation is consistent with the practice guidelines of the American Society of Anesthesiologists.

In other colorectal screening news, a study reported in Archives of Internal Medicine (2009;169:364-371) indicated that mailed reminders to patients are effective. Electronic reminders from a patient’s electronic medical record to the primary-care clinician may also increase screening rates.