Guidelines for colorectal cancer screening 1. Clinicians should perform individualized colorectal cancer risk assessments in all adults. Risk factors for the development of colorectal cancer and death include old age, black race, polyps, personal history of inflammatory bowel disease or colorectal cancer, and the presence of a family history of colorectal cancer. 2. In adults at average risk, clinicians should recommend starting colorectal cancer screening at age 50; in adults at high risk, screening should be started at age 40 or 10 years earlier than the age of the youngest sick relative at the time of colorectal cancer diagnosis (e.g., if a relative is diagnosed with colon cancer at age 45, you need to start screening at age 35). In these populations, the potential benefit of reduced deaths from early detection of colorectal cancer outweighs the potential risk of screening. 3. Screening for patients at average risk should include stool testing, bendable sigmoidoscopy, or fiberoptic colonoscopy. High-risk patients should undergo fiberoptic colonoscopy. The benefits, risks, and availability of specific screening tests, as well as patient preferences, will influence the choice of screening test. For adults over 50 years of age at average risk, the recommended screening interval is a colonoscopy every 10 years, or a bendable sigmoidoscopy, virtual colonoscopy and double-contrast barium enema every 5 years, or annual fecal occult blood testing. 4. Because the potential risk outweighs the potential benefit, clinicians should discontinue colorectal cancer screening for those older than 75 years of age or for adults with an expected survival of less than 10 years.