Knowledge of polyp prevalence and race, stratified by race and sex, is needed to make sound decisions regarding sex or race stratifications (if any) in colon cancer/polyp screening guidelines (either starting age or frequency of surveillance), especially in average-risk individuals. The American College of Gastroenterology recommends that African Americans begin screening 5 years earlier than whites, at the age of 45 years; there are no sex-stratified guidelines proposed by any of the societies. However, in this study of almost 4000 screening (or minimally symptomatic) individuals' first colonoscopy and their follow-up studies after polypectomy over a decade, men had a higher age-corrected prevalence (odds ratio, 1.67 [95% CI, 1.39-2.02]) and a nearly 3-fold increase in the likelihood of having multiple polyps. African American race was not predictive of polyp prevalence or incidence. Although pathological data were not available on all patients' polyps, proportionally, adenomas made up a similar proportion of all polyps in both races in a manual histopathologic review, so these predictors of polyps likely also hold true for adenomas. Screening with colonoscopy earlier and more often in African Americans, simply because cancer or cancer-related death is more common, might not be the best response.