How often should I get a colonoscopy?

Getting a colonoscopy is important to screen for colorectal cancer. But how often you should get a colonoscopy depends on several different factors.

Current guidelines suggest that you get your first colonoscopy at age 45 if you are at average risk for colorectal cancer. If no polyps are found, you won’t need another colonoscopy for another 10 years. But in certain situations, you may need a colonoscopy more often.

We spoke with gastroenterologist Mazen Alasadi, M.D., to learn more.   

High-risk groups encouraged to get more frequent colonoscopies  

Individuals at a higher risk for should get colonoscopies more often than every 10 years. That’s because catching the disease early allows for a greater chance of successful treatment.

“If you have a family history of colon cancer, not only should you get your first colonoscopy earlier, but we also recommend getting a colonoscopy every five years,” says Alasadi. “However, if I find polyps during your colonoscopy, I might not have you wait five years for your next colonoscopy.”

The frequency of colonoscopies increases if you have certain medical conditions.

“If you’ve had colon cancer, you need a colonoscopy one year after undergoing surgery to treat the cancer,” says Alasadi. “Then it’s every three years after that.”

At that point, you’re under surveillance, not screening.

“Screening is what happens when you get your colonoscopy every 10 years and no polyps are found,” explains Alasadi. “When you’ve previously had cancer or we find polyps, you’re under surveillance.”

Patients with Lynch syndrome should get a colonoscopy every one to two years.  Patients with pancolitis, a type of inflammatory bowel disease in which the entire colon is inflamed, should get a colonoscopy more frequently as well. Eight years after their pancolitis diagnosis, they should begin getting a colonoscopy every one to two years.

Colonoscopy results dictate when to schedule your next appointment

In addition to following the recommended guidelines for colorectal cancer screening, it’s important to talk to your doctor about your colonoscopy results to determine when you should have the next one.

“Let’s say you’re at average risk for colorectal cancer, and I find polyps during your first colonoscopy,” says Alasadi. “Now what? Well, it depends on how many polyps we find, the size of the polyp(s), the histology and how well your colon was prepped for the procedure.”

There’s a big difference between removing two or three small polyps and removing 10 polyps that are 10 to 15 millimeters. This is where the histology comes into play.

Any polyps removed are sent to a pathologist to determine what type of polyp it is.

“The results may show that they’re hyperplastic polyps, which are benign. If I find three or four of them, I typically tell the patient to get their next colonoscopy in 10 years,” says Alasadi. “If a pathology report determines one big polyp was a Tubulovillous adenoma with high-grade dysplasia, that means it has the potential to become cancerous, so I’d ask the patient to come back for another colonoscopy much sooner.”

In some cases, you may have sessile polyps removed. These are polyps that stick to the wall of the colon. If you have these polyps, you may need your next colonoscopy sooner.

Colon prep is important

The prep for a colonoscopy is very important. It requires your colon to be completely free of stool so that the doctor can examine your colon during the procedure.

You’ll need to drink a special prep fluid and adhere to a diet of only clear liquids for 24 hours before your procedure. This ensures your doctor can see everything during the colonoscopy.    

While it may not be pleasant, completing the proper prep of your colon gives your doctor the best chance of finding polyps and detecting colorectal cancer early.

“If the prep wasn’t done properly and there is still a lot of stool present, I’ll mark on the patient’s colonoscopy report that the preparation of the colon was poor,” says Alasadi. “In those cases, I may ask the patient to come back sooner.”

Regardless of when you’re scheduled for your next colonoscopy, it’s important to see your doctor if you begin having any symptoms of colorectal cancer.

“If you develop symptoms at any time, we encourage you to come in for a colonoscopy,” says Alasadi. “You don’t have to wait years until your next appointment.”

Request an appointment at MD Anderson online or by calling 1-877-632-6789.