Does a 50-year-old patient with parents in their 90s, no family history of cancer, and no bowel problems need a colonoscopy?
—Joseph R. Arulandu, MD, La Porte, Ind.
The screening recommendations from the American Cancer Society for such an individual are one of the following options: (1) annual fecal occult blood test (FOBT) or fecal immunochemical test (FIT) using the take-home multiple sample method, (2) flexible sigmoidoscopy every five years, (3) FOBT or FIT every year plus flexible sigmoidoscopy every five years, (4) double-contrast barium enema every five years, or (5) colonoscopy every 10 years.
Of the first three options, the combination of FOBT or FIT every year plus flexible sigmoidoscopy every five years is preferable. Colonoscopy should be done if the FOBT or FIT shows blood in the stool, sigmoidoscopy shows a polyp, or double-contrast barium enema studies show anything abnormal. If possible, polyps should be removed during the colonoscopy.
—Michael J. Flamm, MD, assistant professor of clinical medicine, College of Physicians and Surgeons, Columbia University, New York City (115-5)