All You Ever Wanted to Know About Colonoscopies
Dear Susi Q,
I’ve been given conflicting advice from different doctors about the need to get a colonoscopy at my age. I’m 70, with no risk factors that I know of. What is your view on this diagnostic test as we get older? Is there an alternative?
Dr. Jorge Rubal, CEO/CMO Laguna Beach Community Clinic in partnership with the Susi Q responds:
Colorectal cancer (CRC) is a common and lethal cancer and one of the leading causes of cancer death in the United States. Screening for CRC can identify premalignant lesions and detect asymptomatic early-stage malignancy, increasing chances of being cured.
During a patient’s first visit to the Laguna Beach Community Clinic, we regularly conduct an initial risk assessment to determine if you are at increased risk for CRC. Standard of care practice calls for your physician update to assess your health risk at a minimum of every five years. Patients with a personal or family history of CRC or advanced adenomatous polyp and other risk factors may start screening at an earlier age and/or perform screening more frequently.
Most of the harms associated with screening for CRC are related to the risks from colonoscopy, including perforation. The thing to remember is that any abnormal result of initial screening tests other than colonoscopy (e.g., stool test, virtual colonoscopy) necessitates a colonoscopy to evaluate the abnormality; thus, all screening modalities are associated with the potential for colonoscopy-associated complications.
We recommend that average-risk patients aged 45 years and older be screened for CRC. We continue to screen for CRC through age 75 years for average-risk patients, as long as their life expectancy is 10 years or greater. Screening at least until age 75 years for patients at average risk for CRC is recommended by most guidelines. Screening decisions should be individualized and based on shared decision-making for those aged 76 to 85 years. Screening until age 86 may be reasonable for patients who have never been screened, depending on their comorbidities.
Standard of care is a colonoscopy every 10 years for most patients with an average risk for CRC. However, if the patient does not want a colonoscopy other screening modalities include:
- FIT for occult blood annually on a single sample
- Multitarget stool DNA (MT-sDNA) testing every one to three years, or
- By computed tomography colonography (CTC) every five years.
- Less frequently recommended tests include:
- Sigmoidoscopy with FIT or with gFOBT,
- Sigmoidoscopy alone, gFOBT alone
- Capsule colonoscopy.
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