Does a 60-year-old individual with a history of normal colonoscopy 10 years ago require another colonoscopy or can they undergo Fecal Immunochemical Test (FIT) kit or Cologuard (Multi-Target Stool DNA test)?

From the Guidelines

For a 60-year-old with a normal colonoscopy 10 years ago, I strongly recommend getting another colonoscopy rather than just a FIT test or Cologuard. According to the most recent guidelines from the American College of Gastroenterology 1, average-risk adults should undergo screening with any test, including colonoscopy every 10 years, between the ages of 50 and 75 years. Given that it has been 10 years since the last normal colonoscopy, it's time for a repeat screening.

Some key points to consider:

• The American Cancer Society recommends beginning screening at age 45 years with any test, and screening adults between ages 50 and 75 years with any test 1.
• The US Preventive Services Task Force recommends screening adults between ages 50 and 75 years (Grade A) and beginning screening adults between ages 45 and 49 years (Grade B) 1.
• While stool-based tests like FIT or Cologuard are acceptable screening options, they need to be done more frequently (annually for FIT, every 3 years for Cologuard) and any positive result would require a follow-up colonoscopy anyway 1.
• Colonoscopy remains the gold standard as it can both detect and remove precancerous polyps in a single procedure 1.

The risk of developing colorectal cancer increases with age, particularly after 50, and the 10-year interval between normal colonoscopies is based on the typical time it takes for polyps to develop into cancer 1. After this colonoscopy, if results are normal, the next screening would typically be recommended in 7-10 years, though screening recommendations may change as the person ages beyond 75 1.

From the Research

Screening Options for Colorectal Cancer

The decision to undergo another colonoscopy or opt for a Fit kit (Fecal Immunochemical Test) or Cologuard (a type of multitarget stool DNA test) depends on various factors, including the individual's risk profile and previous screening results.

• A study published in 2017 2 aimed to compare the effectiveness of colonoscopy versus annual fecal immunochemical test (FIT) in reducing mortality from colorectal cancer. However, the results of this study are not directly applicable to the given scenario, as it focuses on average-risk individuals aged 50-75 years.
• A 2020 systematic review and meta-analysis 3 compared the efficacy and cost-effectiveness of FIT versus colonoscopy in colorectal cancer screening. The study found that FIT may be similar to one-time colonoscopy in detecting colorectal cancer, although it has lower detection rates of any adenoma and advanced adenoma than one-time colonoscopy.
• More recent studies have explored the development and performance of new stool tests, such as the multitarget FIT (mtFIT) 4 and multitarget stool DNA (MT-sDNA) tests 5, 6. These tests have shown promise in detecting colorectal cancer and advanced adenomas, with some studies indicating that they may be more sensitive than traditional FIT tests.

Considerations for the 60-Year-Old Parent

Given that the 60-year-old parent had a normal colonoscopy 10 years ago, the risk of colorectal cancer is relatively low. However, the decision to undergo another colonoscopy or opt for a non-invasive screening test like Fit kit or Cologuard should be based on individual risk factors and medical history.

• The American College of Gastroenterology recommends that adults with an average risk of colorectal cancer undergo screening every 10 years, starting at age 50 2.
• The 2020 study 3 suggests that annual or biennial FIT may be a cost-effective alternative to colonoscopy every 10 years.
• The newer stool tests, such as MT-sDNA 5, 6, may offer improved sensitivity and specificity for detecting colorectal cancer and advanced adenomas, but more research is needed to fully understand their effectiveness.