Q: At what age should I start getting a colonoscopy?
Dr. Kuldeep Tagore, gastroenterologist, Pacific Permanente Group: There’s no doubt that screening can catch colorectal cancer in the early stages, increasing the chance of survival. Detection and removal of polyps, which are the typical precursor lesion to getting cancer, theoretically may prevent colon cancer entirely. Screening for colorectal cancer generally begins at age 50 for all average risk patients. You may have heard last year the American Cancer Society lowered the recommended age to 45, after studies found that these types of cancers are increasing in younger adults. While this has not yet been widely adopted, it does present an opportunity to have the discussion with your doctor.
There are several different tests to screen for colorectal cancer, and your doctor can recommend the best option for you. Some stool tests are recommended every year, while a colonoscopy is recommended every 10 years. If you have an abnormal stool test, your doctor will want you to follow up with a colonoscopy.
These recommendations apply to people with average risk. If you’ve had abnormal tests or polyps before, if you have an inflammatory bowel disease, or if you have a family history of polyps or colorectal cancer, your doctor might recommend earlier or more frequent screening.
Q: My gynecologist told me that I no longer need an annual exam. Is that safe?
Dr. Stacy Ammerman, OB-GYN, Maui Lani Physicians & Surgeons: For a generation, women were told that they needed to get an annual pelvic exam in order to catch cancers and other problems early. That started to change about 5 years ago, when the American College of Physicians officially recommended that healthy women did not need routine pelvic exams, and that these internal exams should only be conducted as needed. Why the change? Studies found that these exams caused women stress and discomfort, and sometimes led to unnecessary medical procedures — while not offering any real benefit.
Doctors aren’t all in agreement. The American College of Obstetricians and Gynecologists still recommends getting an annual pelvic exam, even though it acknowledges there is no evidence that it makes a difference. This exam can often lead to the diagnosis of asymptomatic infections or lesions that may need treatment. Most gynecologists still do this procedure every year.
The recommendation for pap screening has also scaled back. Women once got a Pap test every year. Now the American College of Physicians recommends women get a Pap test every three years starting at age 21. After they turn 30, they can choose to get a Pap test once every three years when they are screened for HPV (human papilloma virus) at the same time. After turning 65, patients that are not high risk can stop Pap screening. While healthy, low risk women don’t need to be screened as often, doctors might recommend more regular testing for women who are experiencing health problems or who are at higher risk.
* Physicians, providers and administrative staff who practice at Maui Health System hospitals and clinics answer questions from the public in “Healthwise Maui,” which appears on Thursdays. Maui Health System operates Maui Memorial Medical Center, Maui Memorial Medical Center Outpatient Clinic, Kula Hospital & Clinic and Lana’i Community Hospital and accepts all patients. To submit a question, go to the website at mauihealthsystem.org/contact.