Colonoscopy after age 45

Why screening for colorectal cancer starts at age 45

Colorectal cancer usually develops slowly, from adenomatous polyps, that is, small growths in the lining of the bowel that may turn into a tumor after years. Removing polyps prevents cancer, and early detection makes treatment more successful. This is why screening is one of the preventive interventions with the best proven benefit.

American guidelines recommend screening from age 45, after an increase in cases at younger ages was observed, while many European programs start at 50. In practice, from age 45 it is reasonable to discuss the screening plan with the doctor.

Screening options

Colonoscopy examines the whole lining of the large bowel directly and allows polyps to be removed during the same examination. If it is normal in a person at average risk, it need not be repeated for a long period set by the doctor. It is the method with the highest accuracy.

An alternative is the fecal immunochemical test (FIT), which looks for invisible blood in the stool and is repeated regularly. A positive result always calls for colonoscopy. The test is less invasive, but it does not remove polyps and may miss some of them; the choice is made with the doctor according to preference and risk.

When one should not wait until age 45

Blood in the stool, dark stool (melena), iron-deficiency anemia, a persistent change in bowel habit, persistent abdominal pain or unexplained weight loss call for colonoscopy for diagnostic purposes, at any age. Hemorrhoids should not be assumed to be the cause without excluding bowel disease.

Those with a first-degree relative with colorectal cancer or large polyps, especially before age 60, or with inflammatory bowel disease, should start earlier, often from age 40 or 10 years before the relative’s age at diagnosis. This plan is set individually.

Preparation for colonoscopy

The quality of the examination depends on how clean the bowel is. The day before requires a liquid or low-residue diet and a prescribed laxative solution, in one or two doses. Follow exactly the written instruction you receive at booking; poor preparation may require repeating the examination.

Tell the doctor about medicines, especially anticoagulants and antiplatelet agents, and about diabetes and heart disease, and do not stop them yourself. The examination is usually done with sedation, that is, calming with medicines, so you need an accompanying person for the journey home and must not drive that day.

What happens during the examination

The examination usually lasts 20–40 minutes. The doctor inserts a thin flexible tube with a camera through the anus and advances it to the end of the large bowel, while the patient is sedated and feels no significant pain. Bloating from the air introduced may remain afterwards.

Small polyps are removed during the examination, and the tissue obtained is sent for anatomopathological analysis. Complications, such as bleeding after removal of a polyp or perforation, are rare but should be known. The doctor explains the risks before the examination and obtains your consent.

Frequently asked questions

Is colonoscopy painful? It is usually done with sedation, so the patient feels no significant pain and often does not remember the examination. Afterwards some bloating or mild discomfort may remain for a few hours. Eating resumes the same day, according to the doctor’s instruction.

Is preparation the hardest part? Often yes, because the laxative solution tastes unpleasant and causes frequent bowel movements. Keep it cold, drink it slowly and follow the prescribed diet. Good preparation is the main condition for the doctor to see the whole lining and for the examination not to need repeating.

Can the stool test replace colonoscopy? As screening for people without symptoms and at average risk, the fecal immunochemical test (FIT) is an accepted option, but it must be repeated regularly and does not remove polyps. If it is positive, colonoscopy is mandatory. With symptoms or high risk, colonoscopy is needed directly.

Is colonoscopy safe? It is a safe examination when performed by an experienced doctor, but not risk-free. Perforation and bleeding after polyp removal are rare. Risks relate to the general condition and medicines, so the doctor discusses them with you beforehand.

What happens if polyps are found? Small polyps are usually removed during the same examination and sent for anatomopathological analysis. The result shows their type and determines when the next check is due. Removing polyps markedly lowers the risk of cancer.

What should I do if I have a family history of bowel cancer? Tell the doctor: screening may start earlier than age 45, often from age 40 or 10 years before the relative’s age at diagnosis, and at a shorter interval. The individual plan is set after assessing the family history.

After the examination and follow-up

The result of the polyp analysis determines the next step. The interval until the next colonoscopy is set by the doctor according to the number, size and histological type of the polyps, and the clinical check with the doctor is followed at least once a year. A normal colonoscopy does not make attention to new symptoms unnecessary.

Care at Tirana Polyclinic: We perform colonoscopy with sedation and removal of small polyps, with anatomopathological analysis of the tissue obtained. We first assess the indication and the preparation and determine follow-up according to the findings.