What is the optimal age for getting a colonoscopy?

Hello,

Welcome to icliniq.com.

You should have your first screening at the age of 50 years. Since none of your first degree and probably second degree relative had colon cancer at age less than 50 years there is no chance for it. Presence of polyps is a common finding on colonoscopy, that again depends on the polyp size and their biopsy report. But in anyway, there was no colorectal cancer of note, so this is almost negative family history.

Hello,

Welcome back to icliniq.com.

I can completely understand the reason for your anxiety and it is normal to have this when someone in the close family have evidence of polyps.

First, you have to understand what is the risk for an individual and how we assess and say that one is at high risk and the other is not.

Familial risk: Individual whose first degree relative diagnosed colorectal cancer at age less than 60 years of age. Since the development of cancer at old age (after 60 years) does not seem to be genetic related and therefore does not pose a risk of development of cancer in offsprings like in you or in your sister. So you did not have a positive family history and nor you are at high risk for colorectal can based on your family profile.

Individual risk is based on screening and surveillance colonoscopies. Since your father and sister already had their screening colonoscopy, their risk for cancer/polyps (both) depend upon the finding of their screening (first) or surveillance (second, third, fourth and so on) colonoscopies. Your father was at low risk which means number of polyps is less than three and probably benign (non-cancerous) histology. Why I am saying that because if he were a high risk group patient which is described as number of polyps more than three and cancerous histology (tubular or villous adenoma). His surveillance colonoscopy would have been performed much earlier at three years following first colonoscopy i.e. at the age of 53 years. The findings of your sister however, are little ambigous and not clear, I would highly suggest you to upload her colonoscopy plus histology report as I can reveiw that to tell whether she was at high risk or not.

Your sister was however, at low risk for the development of cancers since her family history is not significant for cancer. But anyway she had her colonoscopy for a reason at that young age I also want to know the reason.

Now considering your risk for colorectal cancer I would need two things.

Familial risk : negative as of now.

Individual self risk: Not known since you do not have a colonoscopy ever in your life.

So the guidlines suggest that person with no familial risk of cancer (absence of first-degree relative with colorectal cancer below age 60) should undergo their screening (first) colonoscopy at 50 years of age.

The presence of only polyps on colonoscopy however, can define person's individual risk and timing for the next colonoscopy but cannot define the timing for screening colonoscopy of their siblings or offspring.

I think now you have some idea. Let me know if I am not clear of any above points.

Hello,

Welcome back to icliniq.com.

So that make things more clear. She had colonoscopy because of other reason. And incidentally found to have one adenomatous polyp. But the following statement in the email says nor all such polyps go on to develop cancer.

The doctor in charge of her is bit concerned and that is completely normal, and reasonable if he want to have a follow up colonoscopy in five years on her, in order to ensure your sister and himself as well. This is what guidelines say as well that, if patient found to have adenomatous polyps and if completely removed then the next colonoscopy should be planned after five years (if it were an incomplete removal then follow up colonoscopy would have been at one to three years depending upon physician in charge). That is was all about your sister.

You see that as of now you are still at low risk for cancer. Nor your family nor you have been high risk for development of cancer. I must admit there are studies which can predict the development of colorectal cancer if first degree relative have colorectal cancer. But studies are very limited and often with heterogenous findings to predict the risk of colorectal cancer when one of the first degree relative (sister in your case) have adenomatous polyps. I would tell you that you should wait until your sister's next colonoscopy and see what are the findings then. That would possibly help us to determine whether you need early age colonoscopy (at 40 years) or not.

Hi,

Welcome back to icliniq.com.

You are most welcome. My patients deserve the best possible explanation and solution to their problems. So I just tried the way I always do.