The American Cancer Society Recommends Your First Colonoscopy at age 45

Thank you for your interest in learning more about your upcoming colonoscopy. The following sections provide information about the procedure, how it is performed and why it is important.

Colonoscopy allows a gastroenterologist to examine the entire length of the large intestine. The procedure is used as a method of routine or diagnostic screening for colon cancer. It is also used to explore causes of abdominal pain, rectal bleeding, chronic constipation, chronic diarrhea and other intestinal issues.

During the procedure, the gastroenterologist uses a lighted, flexible tube called a colonoscope that has a small video camera attached to the tip. Using the instrument, the doctor can view the interior of the colon and can remove colon polyps of suspicious tissue for further laboratory evaluation.

Men and women who are at average risk for colon cancer are advised to schedule regular colonoscopies beginning at age 50 (age 45 for African Americans) and at 10-year intervals thereafter. As of May 2018, the American Cancer Society revised the recommended age for a first-time colonoscopy to 45 years old due to an increased incidence of the disease among 45-49 year olds. Patients who have a family history of colon cancer, a condition such as inflammatory bowel disorder (IBD) or any other risk factor for colon cancer may need to begin screening earlier or to be screened more often.

Choosing a qualified gastroenterologist to perform a colonoscopy, a potentially life-saving procedure, is as important as scheduling the appointment itself. One measure of a gastroenterologist’s skill level is his or her adenoma detection rate (ADR). Adenomas are precancerous polyps that GI specialists identify and remove during colonoscopy. The ADR is the proportion of individuals undergoing a colonoscopy who have one or more adenomas, or colon polyps, detected. A higher ADR means the doctor has located and removed precancerous colon polyps from a higher percentage of patients. Removing these pre-malignant polyps (adenomas) significantly reduces the likelihood of developing colon cancer.

How to Prepare for a Colonoscopy

Thorough cleansing of the bowel is essential to have an effective procedure and to avoid retesting. Your gastroenterologist will provide specific instructions for bowel preparation which typically include a pill or liquid laxative and restriction from solid foods a day or two before the test. The following recommendations are general guidelines. Please confirm the details of your preparation instructions with your gastroenterologist.

You will not be permitted to eat or drink the day of the procedure. To avoid dehydration on the day prior to the colonoscopy, drink clear, fat-free bouillon or broth, gelatin, strained fruit juice (no grape juice or any liquid with red color) and water.

Your gastroenterologist will need to know if you have heart disease, lung disease or any other medical condition. Unless otherwise instructed, continue taking your regularly-prescribed medication. You may be asked to stop taking blood thinners or iron supplements in the days before the procedure, but check with the doctor for precise instructions.

Finally, arrange for someone to drive you home afterward because the lingering effects of sedation will make it unsafe for you to drive until the next day.

What Happens During a Colonoscopy?

When it is time to begin the examination, you will lie on your side, and the anesthesiology provider will begin intravenous (IV) sedation. Once sedation has taken effect, the colonoscope will be carefully inserted through the rectum and moved gently around the bends of the colon. As the scope is guided through the colon, the gastroenterologist will view the interior lining on a monitor, remove colon polyps and sample abnormal tissue. The scoping process typically takes 30 minutes.

After the procedure, the nurse will move you to a recovery area, where the sedation will wear off. The gastroenterologist will then visit you to discuss your procedure and immediate findings.

What to Expect After a Colonoscopy?

Depending on the type of sedation (moderate or deep) used for your colonoscopy, it can take anywhere from 30 minutes to an hour to recover from the sedation. You will need someone to drive you home because it can take up to a day for the full effects of the sedative to wear off. You should be able to resume normal activity the next day. Be sure to ask your gastroenterologist when you can resume medications you stopped before the colonoscopy.

If a biopsy was taken during the procedure, the doctor will follow-up with the results. If colon polyps were removed, your doctor may recommend a follow-up colonoscopy in as few as three months depending on the size and number found. If no polyps were found, you will not need a colonoscopy for another 10 years if you are at average risk for colon cancer.

Colonoscopy Findings

Examples of findings during colonoscopy include diverticulosis and colon polyps. If adenomatous polyps (growths of tissue) are found, they will be removed during the colonoscopy and sent to a pathologist.

Polyps are small growths in the lining of the colon. They are common, and they may be benign or cancerous. While the overwhelming majority of colon polyps are benign, if colon polyps were removed, your doctor may recommend a follow-up colonoscopy some time in the future depending on the size and number found.