Oncology (General Cancer)/Colonoscopy frequency
Dear Dr. Higby,
I am a 76-year old male who has been screened for colon cancer at a frequency of 3 to 5 year colonoscopies for more than a decade as recommended by the ACS. 2 years ago during the colonoscopy a single tubulovillous adenoma polyp was removed according to the pathology. The gastroenterology physician recommended that my next colonoscopy be done in 2 year. In the past an occasional polyp has been found, but evidentally the tubulovillous type was not and it is more of concern.
However as I read the recommendations of the ACS the next exam for a person with my history would be in 3 years following the last exam. The only other factors in my history are that my father had a tumor removed from his ascending colon in his early '80's and that as a young child I had colitis.
My concern is that the 2 year screening my family care physician is asking me to submit to now may be premature, that it carries some level of risk and discomfort, and that it is a costly procedure for Medicare.
The gastroenterologist who advised the 2 year follow-up no longer is associated with the clinic where I am cared for so I cannot ask him why he made this recommendation.
In light of the ACS guidelines am I well-based in resisting the exam now and doing it instead next year?
Thanks for any thoughts you have on this question.
PS: I also volunteer at Allexperts in the category of auto repair.
I have a good friend who is an auto mechanic. He's a natural teacher and I used to love to listen to him diagnose what was wrong with my car; the process is very similar to what we physicians do. He is retired now.
As for your question; unless there is something we don't know about which your GI physician is not telling you, you are correct that a three year interval is sufficient. The reasons someone might suggest an earlier interval would be if there was concern that some material might have been left behind; that parts of the colonic mucosa were not adequately visualized; or that there was a "suspicious" area that should be followed up. I don't think your father's situation or your childhood colitis contributes to the recommendation. So unless your doctor can give you another reason (besides the single polyp) I would feel safe waiting three years. Besides, the guidelines of the ACS are quite conservative. A few years ago, the recommendation for routine screening was five years. It was found that stretching the interval out to ten years for those of average risk was not causing harm.
Hope this helps.