Dear Doctors: I am 80 years old, and my physician is concerned regarding the potential risks of the colonoscopy I feel I need. Each colonoscopy I've had has identified several polyps. Given this history, are there alternative diagnostic or screening methods to monitor for polyps?
Dear Reader: Your question hits on two key issues. One is the colonoscopy itself. The other is how older adults make health care decisions as they age out of screening guidelines. With an entire generation now reaching these ages, the decisions you are facing are becoming more common.
Let's begin with colonoscopy. This outpatient procedure is used to look for colorectal cancers, find and remove polyps and flag abnormalities. The current guidelines advise people of average risk to start colorectal cancer screening at age 45. Guidelines advise continuing regular screening until age 75. A colonoscopy involves anesthesia, can result in bleeding and carries a small risk of intestinal perforation. The value of a colonoscopy is that it’s both diagnostic and therapeutic. A polyp can be found, and then it can be removed. Screening from ages 75 to 85 becomes a shared decision between physician and patient. For people of average risk who have had normal results, data show the chance of a high-risk lesion lessens over time.
In our own practices, we lean into the idea that functional age, which includes general health, medical history and well-being, matters more than biologic age. When working with our older patients on these types of decisions, we ask another question as well: If you got an abnormal finding in a lung, breast or colon cancer screening, would you act on it? If the answer is yes and the screening test is not a significant health risk, we suggest screening.
Because prior colonoscopies have found polyps, your interest in continued screenings is understandable. However, not all polyps carry the same risk. At age 80, deciding to keep screening should factor in prior findings. Were the polyps precancerous? Did they pose a significant risk? If the answers are yes, then the next step is for your doctor to assess whether you can safely have a colonoscopy.
The good news is that noninvasive forms of screening tests for colorectal cancers are now widely available. These use a special kit to collect a stool sample at home. Then you mail it to a lab for analysis. The fecal immunochemical test, or FIT, looks for minute traces of human blood in the stool. Results are available a week or two after the sample arrives at the lab. A stool DNA test also looks for the presence of human blood, along with changes to DNA that are associated with cancerous tumors and precancerous polyps. The data show that this test has a high detection rate for early-stage colon cancer. If stool tests yield abnormal results, then the next step is a colonoscopy.
(Send your questions to [email protected], or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)
