When Should I Have a Colonoscopy

Most people have heard that a colonoscopy is a recommended test to look for colon cancer and polyps. However, it is less clear to most about when to have the test.

The standard recommendation for asymptomatic average risk individuals is to have your first colonscopy at age 50 and then at 7-10 if no polyps or other abnormal findings. If you have a family history of colon cancer, you should consider having your first colonoscopy at age 40 or at 10 years younger than your family member was diagnosed with colon cancer (whichever comes sooner). Then even if the test is normal you should have a colonoscopy ever 5 years because of your family history.

So what exactly happens during a colonoscopy? The hardest part of a colonoscopy is actually the evening before when you have to do a “cleanout”. This consists of drinking a cleansing solution and staying near your bathroom for 4-6 hours. The day you do the cleanout you typically should not eat any solid food. (Your doctor’s office will give you specific instructions). The morning of the test you will report to the endoscopy suite hungry (no food or drink after midnight if your test is in the morning!) and an IV will be started. Then you will be wheeled into the endoscopy room and usually either given a mix of sedative (versed), narcotic (fentanyl) or light general anesthesia medication (propafol) into your IV. The choice varies by doctor and facility but typically you won’t remember a thing.

The test itself should take about 30 minutes from start to finish. During the procedure your doctor will look for polyps and/or other abnormal findings in the colon. Polyps should be removed if they are able (usually under 2-3 cm). Otherwise a biopsy will be taken and the spot can be marked with a “tattoo” of specialized ink. All polyps removed will be sent to the lab for a pathologist to examine . The type and size and number of polyps found will determine when you need your next colonoscopy.

Yes, Virginia, you will need more than one colonoscopy in your lifetime! It is important to talk to your doctor and understand when you will need your next colonoscopy. If you have an advanced polyp or many, many polyps you are at increased risk of colon cancer and having colonoscopy at the recommended interval can help prevent colon cancer.

Which brings me to my last point. There are many cancer screening tests recommended for adults today, mammograms to prevent breast cancer, prostate biopsies for prostate cancer, CT scans for lung cancer. Of all these, colonoscopy is the one test that can actually PREVENT cancer! Despite this only 50-60% of all Americans who should have the test are getting it done at the correct times.

Colonoscopy saves lives. Statistics show that the rates of colon cancer are decreasing in the US with increased screening colonoscopy in the last decade. This is why colonoscopy is covered as a benefit on all insurance plans by mandate of the ACA (Affordable Care Act).

So take action…schedule yours today or nudge that parent , spouse or sibling to do theirs. Many people are not even aware of this. A final story.   I have my hair done in a small shop…one day my hair stylists business partner starts asking me questions about colonoscopy; it turns out she has never had one and always put it off. She liked me and decided to come in. Wouldn’t you know, she had a large (1. 5 inch ) polyp on its way to cancer. It was caught on its way to cancer and she was saved major surgery and a permanent colostomy!