Similar to advanced colorectal cancer, the costs of managing end-stage liver disease secondary to HCV is high.2 Moreover, the fact that patients undergoing screening for colorectal cancer are already engaged in care with experts in the treatment of HCV, which reduces the necessity of additional referrals and appointments, must be considered. Limitations The ability to draw inferences regarding the prevalence of HCV in Canada is limited by the specific nature of our study population and small sample size. were determined using logistic regression, and the stored sera of 483?patients who had undergone screening for colorectal cancer between February 2011 and August 2012 were tested for HCV antibodies. Results Among 1012 survey respondents (median age 56 yr; 911 [90.0%] were baby boomers, 880 [87.0%] were white and 223 [22.0%] were born outside Canada), 123 patients (12.2%) reported prior testing for MMP8 Griseofulvin HCV. HCV was previously diagnosed in 9 of these patients (0.9%, representing 1.0% of the patients who were baby boomers): 5 (55.6% of those diagnosed) reported risk factors. Excluding patients diagnosed with HCV, 903 (90.0%) respondents indicated that they would consent to testing of blood or saliva for HCV. After adjusting for age, sex and status of immigration, patients who were white (odds ratio [OR] 3.38, 95% confidence interval [CI] 1.81C6.32) and patients with Griseofulvin risk factors ( ?1 v. 0: OR 3.67, 95% CI 1.12C12.02) had a greater acceptance of screening. Among 483 patients screened for colorectal cancer, 3 were anti-HCV positive (0.6%, 95% CI 0.1%C1.8%), representing 0.8% (95% CI 0.2%C2.4%) of the patients who were baby boomers. Interpretation Acceptance of screening for HCV is high among patients undergoing screening for colorectal cancer in the Calgary area. However, the low prevalence of HCV suggests that the cost-effectiveness of birth-cohort screening in this population warrants evaluation. Chronic hepatitis C virus (HCV) infection is a leading cause of cirrhosis, hepatocellular carcinoma and liver transplantation in Canada. 1 These complications are expected to increase substantially over the next decade2,3 and cause more years of life lost owing to mortality and suboptimal health compared with any other infectious disease.4 Canadian guidelines advocate testing for HCV in people with evidence of liver disease or risk factors including injection drug use, receipt of blood products before 1992, and those from endemic countries.5 However, several characteristics of HCV suggest that more widespread screening may be beneficial. First, HCV infection is common. Although the exact prevalence is unknown, at least 250?000?Canadians (0.8% of the population) are likely infected.2,3 Second, most patients are asymptomatic until advanced liver disease has developed; thus, many patients with HCV are unaware of their HCV infection (21%C70% in Canada3,6 and 50%C75% in the United States).7 Third, therapies are available that Griseofulvin cure the infection in over 80% of patients,8,9 arrest progression of liver disease and reduce mortality.10 Based on these characteristics, recent US guidelines advocated one-time screening for HCV antibodies in individuals born between 1945 and 1965 (baby boomers) plus risk factorCbased screening.11 This birth Griseofulvin cohort has a high prevalence of HCV (3.6% in the US), accounts for 75% of all cases and has the greatest risk of HCV-related mortality.12,13 The Canadian Liver Foundation has endorsed similar recommendations.14 Salivary assays for HCV antibodies, which are approved for clinical use in the US but not Canada, may enhance the acceptance of screening owing to the noninvasive nature of these tests compared with blood-based assays.15 Prior to adopting birth-cohort screening in Canada, the prevalence of HCV and the feasibility of this approach require confirmation. Our study sought to address these issues among patients undergoing colonoscopy for colorectal cancer screening. This unique clinical setting offers several advantages relevant to birth-cohort HCV screening. Because screening for colorectal cancer is recommended for individuals starting at 50 years of age many of whom undergo colonoscopy at regular intervals this patient population is enriched with baby boomers.16 Second, patients who undergo screening for colorectal cancer are engaged in care and have shown acceptance of preventive interventions. Finally, gastroenterologists are in a unique position in that they frequently treat viral hepatitis and also perform screening colonoscopies.17 Unlike primary careCbased HCV screening, this environment ensures direct linkage to counselling and antiviral therapy for infected cases. Methods Study setting The Forzani and MacPhail Colon Cancer Screening Centre (the Centre) is an endoscopy unit in a nonhospital setting located in Calgary, Alberta, that is dedicated to providing colonoscopies for colorectal cancer screening (about 19?000 annually) to residents of Calgary and its surrounding communities (a population of about 1.5?million).18 The Centre accepts referrals for patients who are asymptomatic, in good health and eligible for colonoscopy for colorectal cancer screening (e.g., those at average or increased risk of colorectal cancer, to investigate positive fecal occult blood tests and surveillance in those with a history of adenomatous polyps or colorectal cancer). Colonoscopy for the investigation of symptoms, dysplasia surveillance in patients with inflammatory bowel disease or in patients with major comorbidities that preclude colonoscopy in a nonhospital setting (e.g., decompensated cirrhosis) is not provided. Survey design and administration Patients who are referred to the Centre attend an education session regarding colorectal cancer, which includes information about screening options and preparation for.