Scheduling a colonoscopy may not be the highlight of your week, but the procedure is one of the most important preventive measures against cancer. Arranging this screening test should be a health priority for every individual of the appropriate age.
When should I schedule my first colonoscopy?
Traditionally, routine colonoscopy screenings for asymptomatic people began at age 50. Recent guidelines, however, are now advising that screening should begin at age 45. If the screening colonoscopy was without abnormalities, a follow-up procedure may not be required for 10 years. The interval between colonoscopies would be shorter if a polyp was detected.
Patients at higher risk for colon cancer can begin screenings at even younger ages. Some of the general risk factors include a family history, genetic predisposition, African-American race, history of a prior polyp, or diagnosis with inflammatory bowel disease. Individuals with a family history of colorectal cancer, for example, can begin screenings at age 40, or 10 years younger than the affected relative. Moreover, the recommended interval between tests would be shorter.
What does a colonoscopy screen for?
“A screening colonoscopy is designed to search for polyps and pre-cancerous lesions,” said Dr. Elie Abemayor, a gastroenterologist at Northwell Health Physician Partners/Westchester Health. “30-40% of asymptomatic patients undergoing their first colonoscopy will have a polyp. Approximately half of these polyps are adenomas. This is the type that could potentially develop into cancer.”
Outside of polyps and cancers, other potential findings from a colonoscopy may include diverticulosis (pockets in the colon that could become infected or bleed), hemorrhoids (distended blood vessels in the rectum), and colitis (inflammation in the colon). Should the procedure demonstrate any of these findings, your physician will work with you to determine the best course of management, treatment, and appropriate follow-up.
Who should schedule a colonoscopy?
Colonoscopies are recommended for both men and women. The lifetime risk of developing colon cancer is nearly the same in men (1 in 23) as in women (1 in 24). Early detection of pre-cancerous lesions can significantly improve survival, hence the importance of regular colonoscopy screenings.
Even during COVID-19, medical professionals urge patients to undergo appropriate testing. “Colonoscopies are safe to undergo during COVID-19. To date, the risk of transmission of the virus is extremely low. Moreover, exam facilities have undertaken strict safety precautions to further reduce any risks,” Dr. Abemayor said.
Medical facilities are scheduling fewer procedures, limiting the number of people in waiting areas, and maintaining social distancing in recovery spaces. All staff are wearing appropriate personal protective equipment and patients keep their face masks in place during the procedure. Family members and friends are requested to remain outside the procedure facility to reduce the flow of visitors in the exam space. Finally, patients are tested for COVID-19 3 days prior to the scheduled colonoscopy to exclude patients who may be carrying the virus.
Are there any alternatives to colonoscopy?
A colonoscopy allows the opportunity to diagnose any abnormalities and also treat these findings. Consequently, it remains the standard of care for colon cancer screening. However, this procedure may not be appropriate for all individuals, due to the potential risk for perforation and bleeding – and there are some alternatives to this test.
CT colonography (virtual colonoscopy) allows x-ray software to image the colon. This test still requires a colonoscopy prep and does not allow any therapeutic interventions if an abnormality is seen. Fecal immunochemical testing is designed to detect blood in the stool. This test can be accompanied by a sigmoidoscopy that allows direct visualization of the left-side of the colon. Cologuard testing allows evaluation for both hemoglobin and DNA mutations that are expressed by cancer cells. This test has a high predictive value for colon cancer, but is not as reliable in detecting colon polyps.
If you or a loved one needs to schedule a colonoscopy, please contact Dr. Abemayor’s office at (914) 241-9026 or call your physician for a referral to a gastroenterologist. Cancer prevention begins with proper screening.
By Elie M. Abemayor, MD, Sc.M. Gastroenterologist with Westchester Health, member of Northwell Health Physician Partners