Colonoscopies: Too much of a good thing?

We know that colonoscopies save lives. As mentioned in an earlier blog post, a study by the Yale Cancer Center found that widespread screening has resulted in an estimated 550,000 fewer cases of colorectal cancer over the past three decades.

Given the effectiveness of colonoscopies in saving lives, is it ever possible for patients to have too much of a good thing? According to a study recently published in the Journal of General Internal Medicine, the answer is yes – but read on for the rest of the story.

National guidelines recommend that most adults have a screening colonoscopy beginning at age 50 and every 10 years thereafter, sooner if polyps are discovered. After evaluating detailed electronic health records for 1,429 adults ages 50 to 65 who underwent an initial cancer screening colonoscopy between 2001 and 2010, researchers found that some patients are having colonoscopies too often, thereby exposing themselves to unnecessary risk and expense.

Of the 1,429 adults included in the study, 871 underwent subsequent colonoscopies, on average, six years after the initial procedure. Of those follow-up colonoscopies, 88 percent of screening and one in every two surveillance colonoscopies were performed earlier than recommended. Individuals with a clear colonoscopy (no signs of abnormal growths, such as polyps) underwent a follow-up colonoscopy on average 6.9 years later. When benign (noncancerous) polyps were found, patients were reexamined on average 5.9 years later.

What’s behind the increased frequency of colonoscopies? In a Boston Globe article on the subject, Dr. Lawrence Kosinski, a board member of the American Gastroenterological Association, was quoted as saying he does not believe U.S. doctors are trying to manipulate the system and make more money. “We have many patients whose primary care doctor tells them it’s time to have another one. Or a relative or friend gets colon cancer and they come in afraid,” he said.

In closing, I want to be careful to point out two important truths:

1) The fact that some people are getting colonoscopies too frequently doesn’t mean that too many people are getting colonoscopies. Despite clear proof that screening saves lives, nearly 40 percent of Americans over age 50 have not been screened for colon cancer.

2) It is important to choose wisely when selecting a physician to perform your colonoscopy.

At GIA, our hallmark is performance-based quality care. We have a detailed and complete Quality Performance program that, among other things, reviews indications for colonoscopy and follow-up colonoscopy intervals. Our results are significantly better than national averages. Learn more on our website.

If you’re age 50 or older and have not yet had a colonoscopy, I urge you to schedule yours today. On the other hand, if your physician is recommending a colonoscopy sooner than recommended by national guidelines, I encourage you to ask questions and make sure that having a follow-up screening is right for you.