Frequencies of colonoscopy screenings

[Alan]

I know, yet another thread on colonoscopies

Disclaimer:
I don't like having colonoscopies, plus they are an invasive procedure that have a very small chance of doing serious damage. (I spent 2 days passing blood and had cramps for a week after I'd had my first colonoscopy)

Just before I ER'ed I had a routine colonoscopy screening and 1 small polyp was found and removed. The recommendation was to have another screening in 5 years. I decided to wait until at least 6 years or longer, but at this year's physical DW had a positive result on her faecal occult blood test, and since we'd paid all the deductible on this year's HI we decided to both have a colonoscopy screen before the end of the year (it has been 5.5 years since my last one, longer for DW who had a negative colonoscopy last time).

Three days ago we had our "his and hers" colonoscopy, with our son doing the driving to and from the clinic.

They found 2 small sessile polyps in me (3mm and 5mm), and 3 in DW. (the FOBT was a false positive, as the Doc had predicted)

He recommended that we have another colonoscopy in 3 years, which was not music to my ears. Since I hate the procedure I went onto the NICE site in the UK to see their recommendations. (NICE is the National Institute of Clinical Excellence and provides guidelines to the NHS in the UK).

Their recommendation is for another screening in 5 years, not 3. I've copied out the relevant sections from pages 8 and 9 of the document. For "adenoma", read colon polyp.

Thoughts?

http://www.nice.org.uk/nicemedia/live/13415/53641/53641.pdf

Risk of developing colorectal cancer....

Low risk:
one or two adenomas smaller than 10 mm.

Intermediate risk:
three or four adenomas smaller than 10 mm or one or two adenomas if one is 10 mm or larger.

High risk:
five or more adenomas smaller than 10 mm or three or more adenomas if one is 10 mm or larger.


Offer the appropriate colonoscopic surveillance strategy to people with adenomas based on their risk of developing colorectal cancer as determined at initial adenoma removal.

Low risk: consider colonoscopy at 5 years:
if the colonoscopy is negative (that is, no adenomas are found) stop surveillance
if low risk, consider the next colonoscopy at 5 years (with follow-up surveillance as for low risk)
if intermediate risk, offer the next colonoscopy at 3 years (with follow-up surveillance as for intermediate risk)
if high risk, offer the next colonoscopy at 1 year (with follow- up surveillance as for high risk).

Intermediate risk: offer colonoscopy at 3 years:
if the colonoscopy is negative, offer the next colonoscopy at 3 years. Stop surveillance if there is a further negative result if low or intermediate risk, offer the next colonoscopy at
3 years (with follow-up surveillance as for intermediate risk) if high risk, offer the next colonoscopy at 1 year (with follow- up surveillance as for high risk).

 

[Walt34]

He's having an abundance of caution? There's probably room for a lot of a judgment call on that sort of thing, and perhaps intangibles that are difficult to even articulate. People are not machines that require maintenance at fixed intervals.

 

[Midpack]

I had my first in 2005 with no polyps (thankfully), my next one is 2015 per my GP. I believe a 10 year interval is the norm in the US only if the first one comes up clear. I assume you've seen this already (specifically the tables American Cancer Society recommendations for colorectal cancer early detection.

Be well...

 

[braumeister]

I guess it largely depends on the doc who does it.

During my first one, he whacked off one benign polyp, and wanted me back in five years.

At the second one I had no polyps but he found diverticulosis, so he called the followup for seven years.

That will take me to 2016 or so, by which time I presume the prep will be quick and easy.

 

[bbbamI]

"His and hers" colonoscopy.....how romantic....

DH had small polyps removed the last two times, but they've always told him to have one again in five years and not three.

If you have a PCP, perhaps you could bring the subject up.

 

[Midpack]

That will take me to 2016 or so, by which time I presume the prep will be quick and easy.

Jeeeez, let's hope so, by 2015!

Do NOT read this Dave Barry: A journey into my colon -- and yours (funny but serious).

 

[Alan]

I had my first in 2005 with no polyps (thankfully), my next one is 2015 per my GP. I believe a 10 year interval is the norm in the US only if the first one comes up clear. I assume you've seen this already (specifically the tables American Cancer Society recommendations for colorectal cancer early detection.

Be well...

Every 5 years is also their recommendation for folks with small benign polyps and no family history or other symptoms.

• People with 1 or 2 small (less than 1 cm) tubular adenomas with low-grade dysplasia

• 5 to 10 years after the polyps are removed

• Colonoscopy

• Time between tests should be based on other factors such as prior colonoscopy findings, family history, and patient and doctor preferences.

 

[Alan]

Thanks for the quick feedback folks.

I think we'll give it 5 years unless something changes.

 

[imoldernu]

First... sorry for the discomfort with the procedure. Everyone has different reactions and post operative consequences. Am fortunate in that I have no negatives, and in fact, now request minimum anaesthesia, a I want to see on the screen what the doctor sees and does as he spots and removes small polyps. It has been nearly 25 years since my own initial experience, at a time before some of the newer less invasive operations.

It was from a colonoscopy that I was diagnosed with colorectal cancer. It was prescribed after a fecal stool test, and after considerable intestinal disruption.

As you correctly described, and researched, the occurance of colorectal cancer is not common, and small polyps are almost always benign. That said, in my own case, it was less than a year between a medical ok, and the diagnosis of cancer in the sigmoid colon.

It was before the time of endoscopic, minimally invasive operations, so a little more difficult in the operation itself as well as the recovery period.

As it was, because of being an athelete in early years, my stomach muscles caused the doctor some difficulties, and the normal 3/4 of an hour operation ended up at nearly 4 hours. A sigmoid section, with a total of 39 internal stitches and 14 metal external staples, leaving a 7 inch scar. Am not usually a wimp, but there were 12 days in the hospital that I hardly remember, and three months in recovery, before I could walk upright without pain. No, of course not normal, but that three month hiatus (when I was in the process of expanding my own business) led to my early retirement. It was the percentages of recurrance in the 5 and 10 year periods that made the decision. In my case, fear outweighed whatever the odds might have been.

After the operation, there were annual colonoscopies every year for three years, then every other year for 5 years, and now only once every five years. During this time, some small polyps, but easily removed, tested and clear.

In the interim between 1989 and now, have many friends who had polyps removed, without recurrance, and more recently some friends who have had signmoid sections (in the less invasive mode) with positive results. Today my across the street neighbor and best friend is dealing with unsuccessful radiation and chemo for advanced colon cancer. Not that there was a delay in diagnosis or any procrastination on his part, but a rapid onset (1 year ) case that will not have a good ending. A sad situation, compounded by the fact that halfway through his ordeal, his wife was diagnosed with breast cancer and she too, is not doing well.

Getting older is sometimes difficult, until you consider the alternative.

 

[F4mandolin]

I had my first one while still in the UK at age 53....one polyp. My concerns follow....and disgustingly......
1. My mother had zillions of them....maybe more.
2. My father (so said my mother) was very infrequent with B movements.....I was as well until I discovered prune juice.
3. I have a lousy diet....always have.
4. Its been just over 3 years since my first colonoscopy...might go for another one in about a year.

 

[Alan]

First... sorry for the discomfort with the procedure. Everyone has different reactions and post operative consequences. Am fortunate in that I have no negatives, and in fact, now request minimum anaesthesia, a I want to see on the screen what the doctor sees and does as he spots and removes small polyps. It has been nearly 25 years since my own initial experience, at a time before some of the newer less invasive operations.

It was from a colonoscopy that I was diagnosed with colorectal cancer. It was prescribed after a fecal stool test, and after considerable intestinal disruption.

As you correctly described, and researched, the occurance of colorectal cancer is not common, and small polyps are almost always benign. That said, in my own case, it was less than a year between a medical ok, and the diagnosis of cancer in the sigmoid colon.

It was before the time of endoscopic, minimally invasive operations, so a little more difficult in the operation itself as well as the recovery period.

As it was, because of being an athelete in early years, my stomach muscles caused the doctor some difficulties, and the normal 3/4 of an hour operation ended up at nearly 4 hours. A sigmoid section, with a total of 39 internal stitches and 14 metal external staples, leaving a 7 inch scar. Am not usually a wimp, but there were 12 days in the hospital that I hardly remember, and three months in recovery, before I could walk upright without pain. No, of course not normal, but that three month hiatus (when I was in the process of expanding my own business) led to my early retirement. It was the percentages of recurrance in the 5 and 10 year periods that made the decision. In my case, fear outweighed whatever the odds might have been.

After the operation, there were annual colonoscopies every year for three years, then every other year for 5 years, and now only once every five years. During this time, some small polyps, but easily removed, tested and clear.

In the interim between 1989 and now, have many friends who had polyps removed, without recurrance, and more recently some friends who have had signmoid sections (in the less invasive mode) with positive results. Today my across the street neighbor and best friend is dealing with unsuccessful radiation and chemo for advanced colon cancer. Not that there was a delay in diagnosis or any procrastination on his part, but a rapid onset (1 year ) case that will not have a good ending. A sad situation, compounded by the fact that halfway through his ordeal, his wife was diagnosed with breast cancer and she too, is not doing well.

Getting older is sometimes difficult, until you consider the alternative.

Thank you for taking the time to tell me your story and I'm pleased that it all worked out for you. I've had 3 work colleagues and a friend from church who all have had colorectal cancer and had to go through the surgery to have part of their colon removed. I saw how hard it was for them and know the importance of screening which is why I have now gone through 3 colonoscopies, as well the annual FOBT to check for blood in the stool. Like you my friends also were initially diagnosed through FOBT and/or other symptoms, and they also had positive outcomes after surgery.

With absolutely no family history of the disease and with both the American Cancer Society and the NICE in the UK recommending every 5 years with my test results, I'm just reluctant to subject myself to over testing.

 

[Lakedog]

I had my first colonoscopy last year at age 56 with no polyps or any other issues found. The doc said I should have another in five years. I was expecting ten years from what I've read and based on the experience of others so I was quite surprised at the five year recommendation. I have not decided if I will have one at five years, ten years, or somewhere in between.

 

[Animorph]

I had a few polyps my first time at 53 or so, one just about officially cancer and three or four total I think. The doctor wasn't sure he caught all of the bad one. I was on a one year interval for the next two colonoscopies. I'm at the end of my first three year interval, due in 2014. Not a big deal for me, though I can do without the liquid diet prep.

 

[Ronstar]

Alan, I would ask the doc why he is recommending three years and assess his answer along with other medical advice before you make a decision. After all, your next procedure will be at least 2 years from now. Your level of discomfort with your past procedure should not enter into your decision. Sometimes we have to bite the bullet and have uncomfortable procedures at doctor recommended intervals for our own good.

 

[Meadbh]

With absolutely no family history of the disease and with both the American Cancer Society and the NICE in the UK recommending every 5 years with my test results, I'm just reluctant to subject myself to over testing.

Bingo! I wish doctors were as good at following evidence based guidelines as you are, Alan.

 

[Alan]

Alan, I would ask the doc why he is recommending three years and assess his answer along with other medical advice before you make a decision. After all, your next procedure will be at least 2 years from now. Your level of discomfort with your past procedure should not enter into your decision. Sometimes we have to bite the bullet and have uncomfortable procedures at doctor recommended intervals for our own good.

I certainly will do that. I realize that now is not the time to be making these decisions, plenty of time to cogitate.

 

[Silver]

Bingo! I wish doctors were as good at following evidence based guidelines as you are, Alan.

Sorry to be so cynical, but working in the health care system for 30 years taught me alot about why some physicians practice the way they do. It's
all about the money. They can give you lots of reasons that you really should be tested more often than any guidelines. If these reasons don't seem to ring true in your specific case.....it's about the money.

I've heard physicians say stuff like "well....I really need to see more evidence that the guidelines work before I will consider changing my ordering practices." They are asking you to trust their research and academic brilliance instead of the extensive study by experts already done. I guess that's your choice.

 

[Meadbh]

Sorry to be so cynical, but working in the health care system for 30 years taught me alot about why some physicians practice the way they do. It's
all about the money. They can give you lots of reasons that you really should be tested more often than any guidelines. If these reasons don't seem to ring true in your specific case.....it's about the money.

I've heard physicians say stuff like "well....I really need to see more evidence that the guidelines work before I will consider changing my ordering practices." They are asking you to trust their research and academic brilliance instead of the extensive study by experts already done. I guess that's your choice.

I am a physician who spent a lot of time trying to get other physicians to follow guidelines. In my experience and reading of the literature, the greatest impediment to standardization is traditional physician culture, which emphasizes the individual doctor-patient relationship and the uniqueness of each patient. Combine that with a tendency for narcissists to gravitate towards a profession which (used to) put them on an "expert" pedestal, and you have a recipe for variability in practice that has more to do with physician preferences than with patient needs. There was a research study years ago about the advice that expert surgeons would give to patients with an identical colon cancer scenario. They were all well informed about the evidence, but their recommendations were all over the map. Now that the principles of quality improvement are being incorporated into medical curricula, and some influential physician leaders get it, some improvement is occurring. Informed patients help too.

 

[F4mandolin]

I am a physician who spent a lot of time trying to get other physicians to follow guidelines. In my experience and reading of the literature, the greatest impediment to standardization is traditional physician culture, which emphasizes the individual doctor-patient relationship and the uniqueness of each patient. Combine that with a tendency for narcissists to gravitate towards a profession which (used to) put them on an "expert" pedestal, and you have a recipe for variability in practice that has more to do with physician preferences than with patient needs. There was a research study years ago about the advice that expert surgeons would give to patients with an identical colon cancer scenario. They were all well informed about the evidence, but their recommendations were all over the map. Now that the principles of quality improvement are being incorporated into medical curricula, and some influential physician leaders get it, some improvement is occurring. Informed patients help too.

Eh? You mean take responsibility for yourself and do the research....because you are the one who REALLY should make the decisions?

 

[Meadbh]

Eh? You mean take responsibility for yourself and do the research....because you are the one who REALLY should make the decisions?

Yes (if you means the patient).

 

[AllDone]

I know, yet another thread on colonoscopies

They found 2 small sessile polyps in me (3mm and 5mm), and 3 in DW. (the FOBT was a false positive, as the Doc had predicted)

He recommended that we have another colonoscopy in 3 years, which was not music to my ears. Since I hate the procedure I went onto the NICE site in the UK to see their recommendations. (NICE is the National Institute of Clinical Excellence and provides guidelines to the NHS in the UK).

Their recommendation is for another screening in 5 years, not 3. I've copied out the relevant sections from pages 8 and 9 of the document. For "adenoma", read colon polyp.

Thoughts?

http://www.nice.org.uk/nicemedia/live/13415/53641/53641.pdf

Actually, not all polyps are adenomas. The recommendation for adenomas and hyperplastic polyps are different since adenomas are considered to be potentially cancerous and hyoerplastic polyps are like skin tags. Without risk factors follow up screening for hyperplastic polyps is generally 10 years. (Diverticulosis does not require routine screening.) I recommend having a talk with your PCP.

Colon polyps: Causes - MayoClinic.com

 

[Alan]

Eh? You mean take responsibility for yourself and do the research....because you are the one who REALLY should make the decisions?

I don't see why I shouldn't take responsibility for the decision. I have had 2 colonoscopies with 2 different specialists and 2 identical results. However, the 2nd specialist has given me a different, more frequent and costly, recommendation. I can see no reason why I shouldn't seek a 3rd opinion, even if that comes from research done by myself looking into respected organizations such as the ACS and NICE. I will make my final decision in 3 years when the time comes, after further advice from my PCP here, and also possibly in the UK (I should be dual resident then).

 

[Alan]

Actually, not all polyps are adenomas. The recommendation for adenomas and hyperplastic polyps are different since adenomas are considered to be potentially cancerous and hyoerplastic polyps are like skin tags. Without risk factors follow up screening for hyperplastic polyps is generally 10 years. (Diverticulosis does not require routine screening.) I recommend having a talk with your PCP.

Colon polyps: Causes - MayoClinic.com

Thanks, I am jumping the gun as I don't have the test results yet, but neither does the specialist who is already recommending a return visit in 3 years, "for surveillance".

 

[JakeBrake]

Had my third colonoscopy at five year intervals in 2010. This time Doc discovered a couple of polyps (which were removed) and diverticulosis. I was told to come back in 2015.

So, in 2011 I had a heart scare. This time the ER doc ordered a C-T scan because I was experiencing pain in my mid-section (Turned out to be a pulled muscle). The C-T scan showed the diverticulosis and would have shown the polyps if they had not been removed.

My question is. Why do a colonoscopy if a C-T scan will show the same things? It appears to me the C-T scan is less invasive.

 

[MRG]

Had my third colonoscopy at five year intervals in 2010. This time Doc discovered a couple of polyps (which were removed) and diverticulosis. I was told to come back in 2015.

So, in 2011 I had a heart scare. This time the ER doc ordered a C-T scan because I was experiencing pain in my mid-section (Turned out to be a pulled muscle). The C-T scan showed the diverticulosis and would have shown the polyps if they had not been removed.

My question is. Why do a colonoscopy if a C-T scan will show the same things? It appears to me the C-T scan is less invasive.

I was told the colonscopy was more accurate. It had to be done according to the specialist. CT had revealed what may have been an issue. I'd had food poisoning for 3 days before the colonoscopy. I wish I'd had a picture when the doc told me I needed this procedure, along with the prep. I'm done with that hospital.
MRG