Colonoscopy: Why Should I?

While the American Cancer Society (ACS) (2019) indicates that colon cancer deaths have decreased over the past three years, they still indicate that more deaths can be prevented through the utilization of screening colonoscopies. The disturbing news is that colorectal cancer incidence and death rates for those ages 20 to 54 is on the increase (ACS, 2019). There are more and more younger individuals diagnosed with colorectal cancer, yet the screening guidelines of age 50 is still the standard (US Preventative Services Task Force {USPSTF}, 2016). There has been discussion among medical professionals on the need to decrease the screening to age 45 or younger, yet no guideline changes have been implemented at this time (Cameron & Moss, 2018).

Health care providers are faced with many patient challenges, yet recommendation of a screening colonoscopy at the age of 50 should not be one of them (USPSTF, 2016). The American Cancer Society (2019) 2018 rankings indicate that colorectal cancer is the third leading cause of cancer in both males and females. While providers have to consider individual risks and benefits, for most individuals, beginning at the age of 50, providers should be recommending and referring their patients for a screening colonoscopy. Patients have many reasons for choosing to not undergo a screening colonoscopy. Those reasons range from practical barriers, discomfort, personal integrity, multimorbidity, feeling healthy, not having the energy, belief that cancer is not present, complications, and distrust in the accuracy of the iFOBT (Bie & Brodersen, 2018). Healthcare providers, more often than not, get the question as to why do I need a colonoscopy.

A retrospective chart review over an 18 month time span was conducted in a general surgery office located in northwestern Alabama. The diagnostic code for screening colonoscopy was utilized to pull a list of patient’s names who underwent a screening colonoscopy during the designated time frame. Chart reviews looked at age, gender, polyps, classification of polyp, adequate prep, recommendation of when to repeat, and sedation type. Over 500 charts were reviewed.

The American Society for Gastrointestinal Endoscopy (2019) estimates that the average 60-year old has a 25% chance of having a polyp. Other studies indicate that around 34% of patients undergoing screening colonoscopies will have polyps (JAMA and Archives Journals, 2011). For patients in northwestern Alabama, referred to a general surgeon’s office, for a screening colonoscopy, the incidence of finding polyps among all ages was 44.8%. This exceeds rates reported in previous research studies.

With findings indicating the prevalence of polyps being higher than other research indicates in the area of northwestern Alabama, health care providers have an even stronger reason to encourage their patients to undergo screening colonoscopies. So, when patients ask why, not only do they need to know the standard reasons, of age and normal risk factors, they also need to know that their geographic location may have a higher prevalence of colon polyps.