From the Guidelines
Colonoscopy is recommended every 10 years as a first-tier option for screening of colorectal neoplasia, due to its high-quality evidence and strong recommendation. This is based on the latest guidelines from the U.S. Multi-Society Task Force on Colorectal Cancer, published in 2022 1. The task force suggests that adults at average risk should undergo high-quality colonoscopy every 10 years or an annual FIT as first-tier options for screening of colorectal neoplasia.
Key considerations for colonoscopy include:
- A complete colonoscopy to the cecum, with photo-documentation of the appendiceal orifice, ileocecal valve, or terminal ileum
- Adequate bowel preparation, which is essential for proper visualization of the colon lining
- The procedure should be performed by a colonoscopist with a 25% overall adenoma detection rate
It is also important to note that the decision to stop screening should be based on individual factors, such as age and comorbidities. The task force suggests that individuals who are up to date with screening and have negative prior screening tests, particularly high-quality colonoscopy, consider stopping screening at age 75 years or when life expectancy is less than 10 years 1. However, persons without prior screening should be considered for screening up to age 85, depending on consideration of their age and comorbidities.
In terms of population considerations, while data shows that the United States has sufficient colonoscopy capacity to support expanding screening to 45- to 49-year-olds with colonoscopy either as a primary or follow-up test, it is unclear whether colonoscopy access is equitable 1. Further research is needed to determine the optimal screening and neoplasia surveillance intervals for younger individuals, as well as the impact of primary prevention interventions in early adulthood on long-term cancer risk.
From the Research
Colorectal Surgeon Recommendations for Colonoscopy
- Colorectal surgeons recommend colonoscopy as a screening modality for colorectal cancer, with guidelines suggesting screening between 45 and 75 years for average-risk individuals 2.
- For high-risk individuals with a positive family history of colorectal cancer or advanced colorectal polyp, screening should begin at age 40, with colonoscopy recommended every 5-10 years 2.
Screening Modalities and Intervals
- Colonoscopy is a frequently suggested screening modality, along with FIT (fecal immunochemical test) and CTC (computed tomography colonography) 2.
- Recommended screening intervals include:
Bowel Preparation for Colonoscopy
- Adequate bowel cleansing is essential for thorough visualization of the colon and successful detection of colon polyps 3, 4, 5, 6.
- Split-dose polyethylene glycol is superior to single-dose for colonoscopy preparation, resulting in better bowel cleanliness and less overall fluid in the colon 5.
- Sodium phosphate versus polyethylene glycol for colonoscopy bowel preparation is still under debate, with some studies suggesting sodium phosphate is a better agent due to its higher efficacy, better tolerability, and acceptability 6.