At what age should a patient have their next colonoscopy (colon examination) if their mother had precancerous colon polyps at age 50 and they had a normal colonoscopy at age 31?

From the Guidelines

A patient with a family history of precancerous colon polyps in their mother at age 50 and a normal colonoscopy at age 31 should have their next colonoscopy at age 40. This recommendation is based on the most recent and highest quality study, which suggests that individuals with a single first-degree relative with CRC or advanced adenomas should begin screening at age 40 years, with the same options and intervals as those for average-risk persons 1. The patient's family history of precancerous colon polyps in their mother at age 50 places them at increased risk for colorectal cancer, and the standard follow-up interval for individuals with normal findings and increased familial risk is 5-10 years. However, the latest guidelines from the U.S. Multi-Society Task Force on Colorectal Cancer recommend that persons with a single first-degree relative with CRC who was diagnosed at age 60 years or older should begin screening at age 40, with the same options and intervals as those for average-risk persons 1. Key points to consider include:

• The patient's age and family history
• The results of their previous colonoscopy
• The latest guidelines and recommendations for colorectal cancer screening
• The importance of maintaining a surveillance schedule to reduce the risk of developing colorectal cancer. It's also important to note that if any polyps or abnormalities are found during the follow-up colonoscopy, the interval for subsequent screenings may need to be shortened based on those findings, as individuals with a family history of precancerous polyps have approximately a 2-fold increased risk of developing colorectal cancer compared to those without such history 1.

From the Research

Determining the Next Colonoscopy Age

Given the patient's mother had precancerous colon polyps at age 50 and the patient had a normal colonoscopy at age 31, we need to consider the guidelines for average-risk and high-risk individuals.

• The patient is considered to be at higher risk due to their family history of precancerous colon polyps 2.
• For high-risk individuals with a positive family history of colorectal cancer or advanced colorectal polyp, screening should begin at age 40 or 10 years before the age of the youngest case in the family 2.
• Since the patient has already had a normal colonoscopy at age 31, the next colonoscopy should be scheduled based on the guidelines for high-risk individuals.
• The recommended screening interval for high-risk individuals is every 5-10 years 2.

Screening Interval Considerations

• Emerging evidence supports the eventual endorsement of 15-year intervals for patients with normal examinations 3.
• However, this patient is considered high-risk due to their family history, so a shorter screening interval is recommended.
• The patient's next colonoscopy should be scheduled at an age that takes into account their family history and the recommended screening interval for high-risk individuals.

Recommended Next Colonoscopy Age

• Based on the guidelines for high-risk individuals and the patient's family history, the next colonoscopy should be scheduled in 5-10 years 2.
• Assuming the patient had their first colonoscopy at age 31, the next colonoscopy should be scheduled around age 41 (31 + 10 years) or earlier if recommended by their doctor.