The American College of Gastroenterology has issued updated evidence-based screening guidelines for colorectal cancer (CRC), including a new recommendation to begin CRC screening at age 45 for average risk adults. Key updates include recommendations for screening individuals with family history of CRC or polyps, guidance on the use of aspirin to reduce the risk of CRC, quality indicators for adenoma detection rate and colonoscopy withdrawal time, as well as suggestions about evidence-based interventions to boost screening rates, especially among African Americans. The authors distinguish between one-step screening tests, such as colonoscopy, and two-step screening tests that require colonoscopy, if positive, in order to complete the screening process.