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Canadian Journal of Gastroenterology
Volume 24, Issue 12, Pages 705-714
Special Article

Canadian Association of Gastroenterology Position Statement on Screening Individuals at Average Risk for Developing Colorectal Cancer: 2010

Desmond J Leddin,1 Robert Enns,2 Robert Hilsden,3 Victor Plourde,4 Linda Rabeneck,5 Daniel C Sadowski,6 and Harminder Singh7

1Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
2St Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
3University of Calgary, Calgary, Alberta, Canada
4Centre de santé et de services sociaux Pierre-Boucher, Longueuil and University of Montreal, Montreal, Quebec, Canada
5University of Toronto, Toronto, Ontario, Canada
6Royal Alexandra Hospital, University of Alberta, Edmonton, Alberta, Canada
7Departments of Internal Medicine and Community Health Services, University of Manitoba, Winnipeg, Manitoba, Canada

Received 24 August 2010; Accepted 30 August 2010

Copyright © 2010 Canadian Association of Gastroenterology. This open-access article is distributed under the terms of the Creative Commons Attribution Non-Commercial License (CC BY-NC) (, which permits reuse, distribution, and reproduction of the article, provided that the original work is properly cited and the reuse is restricted to noncommercial purposes.


The Canadian Association of Gastroenterology and the Canadian Digestive Health Foundation published guidelines on colon cancer screening in 2004. Subsequent to the publication of these guidelines, many advances have occurred, thereby necessitating a review of the existing guidelines in the context of new technologies and clinical knowledge. The assembled guideline panel recognized three recent American sets of guidelines and identified seven issues that required comment from a Canadian perspective. These issues included, among others, the role of program-based screening, flexible sigmoidoscopy, computed tomography colonography, barium enema and quality improvement. The panel also provided context for the selection of the fecal immunochemical test as the fecal occult blood test of choice, and the relative role of colonoscopy as a primary screening tool. Recommendations were also provided for an upper age limit for colon cancer screening, whether upper endoscopy should be performed following a negative colonoscopy for a positive fecal occult blood test and when colon cancer screening should resume following negative colonoscopy.