He has no other significant past medical history. He has a family history of colonic polyps in a brother and an aunt, both diagnosed after age 60. His physical exam is unremarkable. This patient probably has an average risk and as such should have had screening for colorectal cancer initiated 5 years earlier. Iron deficiency anemia is an uncommon mode of presentation in colon cancer.
Cigarette smoking is a well-known risk factor for colon cancer.
This patient's initial colon exam is best done with a double-contrast barium enema. If he had a colonoscopy that revealed only angiodysplasia, he should be followed with colonoscopy every year.