Oh boy, if you’re facing another colonoscopy, I may have good news for you.

A new study has found that many doctors are routinely scheduling patients for repeat colonoscopies every seven years, and that this is unnecessary for patients with no indication of precancerous conditions.

The American Cancer Society (ACS), the American Gastroenterological Association (AGA), the US Preventive Services Task Force (USPSTF) and other august bodies long ago set the guidelines for routine colonoscopy screenings to take place every 10 years starting at age 50, and that recommendation has not changed.

I repeat, it has not changed. Furthermore, the USPSTF guidelines say that if you are 75 or older, you may never need to have another colonoscopy… ever. There are definite exceptions to these recommendations for a few groups of people, as I’ll explain.

A recent study published in the Archives of Internal Medicine made it clear that colonoscopies are being overprescribed.

Specifically, it revealed that nearly 50% of 24,071 Medicare patients had the screening within seven years, rather than the prescribed 10… and that 42% of these patients had no clear medical reason for doing so (such as polyps detected in a previous screening, rectal bleeding or other sign of cancer or precancerous conditions).

BEFORE THERE WAS COLONOSCOPY

To discuss the study findings, I spoke with the lead researcher, James S. Goodwin, MD, chair of geriatric medicine and director of the Sealy Center on Aging at The University of Texas Medical Branch in Galveston.

He explained that before colonoscopy came along, screenings for colon cancer were much less invasive —

people might have a fecal occult blood smear (this is from a stool smear taken in your doctor’s office or that you do at home)…

or a sigmoidoscopy, in which the doctor inserts a small, flexible tube with a light on it to inspect just the rectum and lower (sigmoid) colon, unlike the entire colon as is done in a colonoscopy… or a double contrast barium enema that uses X-rays to identify problems.

After the colonoscopy came on board, Dr. Goodwin says, the idea was that any potential problem revealed by a fecal occult blood test or one of the other earlier screenings would lead to a colonoscopy, but it didn’t happen that way.

Instead, colonoscopy replaced the other types of screening.

Doctors like the colonoscopy because it allows them to see the full colon, as well as to excise any precancerous polyps they find at the same time they are performing the examination.

This makes colonoscopy a sort of two-for-one deal — the screening and the solution. “That is the good part,” says Dr. Goodwin, “but the bad part is doing them more frequently than is needed.” So, why did doctors start doing more and more colonoscopies?

BETTER SAFE THAN…

Colon polyps fated to become cancerous do so at an extremely slow rate.

For example, in a Mayo Clinic study started in the 1960s, in patients in whom barium enemas had identified large polyps (the kind most likely to be on a faster track to cancer), 10 years later, only 8% of these large polyps had become cancerous, and none of the patients had died as a result of the cancer.

Nevertheless, the common attitude is that additional colonoscopy screenings can’t hurt, so why not do them? But that is far from the whole story, says Dr. Goodwin.

The major associated risk with colonoscopy is perforation of the colon — this and other complications occur in one in every 1,000 procedures with the result of one death per 10,000.

Colonoscopy bowel prep can also have disturbing consequences — as I witnessed last year when a friend nearly died from it.

Drinking down the laxative solution at a rapid rate triggered such forceful vomiting that it ruptured my friend’s esophagus, landing him in intensive care for 10 days.

Dr. Goodwin says that he finds that many of his elderly frail patients are impacted by the prep, though, fortunately, in a generally less dramatic fashion.

“It can set off a cycle of diarrhea and constipation that makes them miserable for some time,” he says.

TIME TO HAVE ONE

Let’s review the recommendations provided to patients and doctors from the American Cancer Society and others for when to have a colonoscopy screening.

These apply to people having no symptoms, no special issues and who have not had polyps in previous screenings, all of whom can dial back on the frequency of colonoscopies.

The recommendations are…
A baseline colonoscopy at age 50 and every 10 years after that.

A screening (which includes colonoscopy, fecal occult blood test or a sigmoidoscopy) for people between the ages of 75 and 85 if, and only if, symptoms are present.

Recommendations for having more frequent colonoscopy screenings include…

If you have a first-degree relative who has or had colon cancer before age 60, be sure to schedule a colonoscopy starting at age 40 and then as frequently as your doctor recommends.

If you suffer from inflammatory bowel disease, you should have a colonoscopy more often, and you should start at an age younger than 50. You should discuss appropriate scheduling with your gastroenterologist.

If you have any possible symptoms of colon cancer, including bleeding from the rectum, blood in the stool, chronic abdominal pain and/or unexplained weight loss, discuss a colonoscopy with your physician.

When your doctor advises a colonoscopy under ordinary circumstances and before 10 years are up, Dr. Goodwin says, there is a good way to investigate whether it is really necessary.

“Without being adversarial, simply ask your doctor why it is important for you to do this,” he says. “The doctor may have an excellent reason or, thinking it over more fully, may conclude it isn’t necessary for you at this point. All you have to do is ask,” he says.

Source(s):

James S. Goodwin, MD, chair of geriatric medicine and director of the Sealy Center on Aging at the University of Texas Medical Branch Galveston.