A colonoscopy is one of several screening tests used to detect and prevent colon cancer. According to the American Cancer Society, it is the most thorough test available and is the only one that allows removal of detected polyps during the examination. How often you a colonoscopy, and when you should have your first one, depend on your level of risk for . Guidelines developed jointly by the American Cancer Society, the U.S. Multi-Society Task Force on Colorectal Cancer and the American College of Radiology specify recommendations for persons at three risk levels.
Recommendations for Persons at Average Risk
You are at average risk of developing colon cancer if there is nothing about your medical history or lifestyle to indicate otherwise. (For detailed information about specific risk factors, see the resources section of this article.) The recommendation for colon cancer screening for persons of average risk is to have one type of screening test done at age 50. If you choose to have a colonoscopy and the results are normal, you should have repeat colonoscopies every 10 years. If you choose another type of test for initial screening and the results are positive, you will then need to have a colonoscopy for further examination.
Recommendations for Persons at Increased Risk
You have an increased risk of developing colon cancer if you have ever had colon cancer or polyps in the past, or if you have one or more immediate family members with a history of colon cancer or polyps. If you have had one to two small polyps removed, the recommendation is to have another colonoscopy in five to 10 years. If you have had three to 10 polyps in the past, or one especially large polyp, you should have a colonoscopy three years after their removal. If you have had more than 10 polyps removed at once, you should have a colonoscopy within three years, and if you have had a large polyp removed in pieces, you should have a colonoscopy within two to six months.
If you have been diagnosed with or had surgery to remove colon cancer, you should have another colonoscopy within three months to one year. If that result is normal, you should repeat the test in three years, and every five years thereafter if the result is normal.
Persons with a strong family history of colon cancer should have their first colonoscopy at age 40, or 10 years before the age of the youngest family member at diagnosis, whichever comes first. The recommendation is to repeat the colonoscopy every 5 years. However, if the family member was older than age 60 when diagnosed, the recommendation is to have the initial colonoscopy at age 40 and repeat every 10 years.
Recommendations for Persons at High Risk
Persons with a high risk of developing colon cancer are those with a family history of colorectal cancer syndromes such as hereditary non-polyposis colon cancer (HNPCC) or familial adenomatous polyposis (FAP), and those who have an inflammatory bowel disease such as Crohns disease or ulcerative colitis. Recommended intervals for a colonoscopy for persons at high risk are generally one to two years, and the recommended age for initial screening is as early as 20 to 25 years in some cases. Persons at high risk should be under the care of specialists who can closely monitor their conditions and make appropriate recommendations for testing.
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