Ask the Doctor: sigmoidoscopy or colonoscopy as a screening option?
Neal Meropol, M.D.
Colon cancer screening options can be confusing, especially when some insurance companies cover one procedure and not another. This Ask The Doctor question comes from a reader with a family history of colon cancer who needs to sort through different screening options in order to make the best choice for himself and his family.
Get Your Rear in Gear reader: I have had sigmoidoscopies every five years starting at 50 (the last one was at age 65, a year and a half ago). During the first one, two precancerous polyps were removed. Since then, no further polyps. My dad had colon cancer and had section of his intestine removed and never had a further problem. I just heard from my brother that during a colonoscopy, two polyps were removed. His doctor recommended that he be rechecked in one year and that I be checked as well.
Two questions: 1) Given that my HMO has never recommended a colonoscopy, should I request one now (or at least when Medicare will cover it in January)? 2) I have a daughter who is 42; should I recommend to her to get one now?
Dr. Meropol: This is a good question. It is generally recommended that a colonoscopy (an evaluation of the entire colon) be the screening method of choice for anyone at an increased risk of colon cancer. Having a first-degree relative (parent, child, sibling) with colon cancer puts you in this category. That said, the next question is: how great is your risk? The answer depends on several factors, including:
- How many first degree relatives had colon cancer?
- How young were they at diagnosis?
- Are there other cancers in the family that might suggest a true hereditary syndrome (i.e. very high risk)?
With regard to polyps, the follow up intensity depends on how many, what size, and what they looked like under the microscope. When your doctors make a recommendation for type of colon cancer screening and its frequency, they will be considering these types of issues.
Neal Meropol is Section Chief in Medical Oncology at University Hospitals Case Medical Center & Case Western Reserve University and Associate Director for Clinical Research at Case Comprehensive Cancer Center, in Cleveland, Ohio. Read more…
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My father had 5 colonoscopies in a row. The first 4 were said to be clear. The fifth was stage 4 colon cancer. They said it was probably 5 years old. Evidentally they suspected something, to have a colonoscopy every year. His was all the way to the end, where they say the scope doesn’t reach. If the suspected something, don’t they have extensions, or liquid to drink or something? If they know this happens, why don’t they make something so they can reach this area. Sounds very wrong to me. My Dad did 5 years of almost constant chemo. He’s been off chemo since November 2009. He is in transition at this time, at home