Highlights of the 2009 Colon Cancer Screening Guidelines:

* This is an update to the guidelines issued in 2000, in which ACG elected to provide specific recommendations, all of which were assessed using the GRADE system to provide the strength of evidence supporting each recommendation. * Highlights of the guidelines: * Colonoscopy is the preferred CRC prevention test. Colonoscopy every 10 years beginning at age 50 remains the preferred strategy for CRC screening. Alternatives for patients who decline colonoscopy are flexible sigmoidoscopy or computed tomography (CT) colonography. * Screening for black persons should begin earlier. The updated guidelines include a new recommendation to begin CRC screening in black persons at age 45 because of the high incidence of CRC and a greater prevalence of proximal or right-sided polyps and cancerous lesions in this population. * New recommendations for bowel preparation aim to enhance effectiveness and improve tolerability for patients. To improve the quality of colonoscopy exams and the tolerability of bowel preparation, the ACG believes that the best method of bowel preparation is “split dosing”, whereby the patient takes at least half of the preparation on the day of the colonoscopy rather than the entirety of the prep on the day before. Another new rec’d is that patients be allowed to ingest clear liquids until 2 hours prior to sedation, consistent with practice guidelines of the American Society of Anesthesiologists. * CT colonography (also known as virtual colonoscopy) performed every 5 years is endorsed in the updated ACG guidelines as an alternative to colonoscopy performed every 10 years in patients who decline the traditional modality. This is in light of recent studies which revealed that this test has a 90% sensitivity for colon polyps > 1cm. Limitations are present, though. It is not considered equi valent to colonoscopy as a screening strategy because of its inability to detect polyps < 5mm which constitute 80% of colorectal neoplasms, and because false positives are common. Additionally, there are concerns about the radiation risk associated with even a single test. * Barium enema is not recommended for CRC screening/prevention because the quality of performance is variable given the few remaining centers that are able to achieve high-quality testing with this somewhat dated imaging technique. * Fecal testing is categorized as a cancer detection test, not a cancer prevention test as above. Fecal immunohistochemical testing (FIT) replaces older guaiac-based fecal occult blood test and is recommended as the preferred cancer detection test (performed annually). FIT has superior performance characteristics compared with older guaiac-based Hemoccult II cards, with a comparative doubling in the detection of advanced lesions and little loss of positive predictive value.

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