Screening for cancerous and precancerous conditions of the colon

Five points for the primary care physician: 1. Colorectal cancer (CRC) is the second leading cause of cancer-related death in both men and women in the United States. 2. Guidelines recommend initiating CRC screening in average-risk patients at age 50 years, but in African Americans at age 45 years. 3. It is preferred that an informed decision is made by the patient with the help of their clinician about the type of screening test based on the patient's personal preferences. 4. Patients with personal history of chronic ulcerative colitis and Crohn colitis have significant cancer risk 8 years after the onset of pancolitis or 12 to 15 years after the onset of left-sided colitis. Colonoscopy every 1 to 2 years should be performed, with biopsies for dysplasia. 5. Counseling to consider genetic testing and early screening recommendations for those with personal or family history of familial adenomatous polyposis or hereditary nonpolyposis colorectal cancer.