Home Blog Some People Getting Colonoscopy Screening Too Often Some People Getting Colonoscopy Screening Too Often May 16, 2011 • By Sharyn Worrall Resources and Research Blog After a normal colonoscopy when no polyps are found, guidelines call for a repeat test in 10 years. However, almost half of Medicare patients with a negative colonoscopy got another exam within 7 years, and for one in four, there was no clear evidence that they needed one. Because colonoscopies have real risks and are expensive, over-testing can be both dangerous and costly. Given limited numbers of physicians who do colonoscopies, unnecessary procedures add to long waiting lists for screening and for necessary follow-up exams. Although Medicare regulations call for reimbursement only after 10 years in cases where the first procedure didn’t find a problem, payments are being made for earlier exams. In fact, Medicare denied payment for only 2 percent of colonoscopies for which there was no clear indication of need. Researchers at the University of Texas in Galveston reviewed a representative sample of Medicare claims for colonoscopy between 2001 and 2003. Since they were looking for average-risk patients who had a negative screening colonoscopy, they filtered out any tests that included removing a polyp or a biopsy or other procedure is done during the exam. They also removed any colonoscopies that included a diagnosis such as bleeding or pain and any that were done for patients who had a Medicare claim in the previous 3 months that included a diagnosis or symptoms of colorectal disease that might have indicated the need for a diagnostic colonoscopy. In their sample of 5% of the Medicare population: 236,145 Medicare patients 66 and older had a colonoscopy in 2001-2003. 114,468 had a negative exam with no polyps removed, no biopsies or other procedures. 24,071 had a negative screening colonoscopy after all possible medical reasons for doing the test were eliminated. The research team then looked for repeated colonoscopies within 5 and 7 years of the first test. Again they eliminated any exams for which diagnosis or other Medicare claims indicated a good reason to repeat the test. If they couldn’t find a reason, they classified the colonoscopy as repeated with no clear indication. In their sample of 24,071 who had a completely negative screening colonoscopy between 2001 and 2003, 8,608 had another colonoscopy within 7 years, and for 3,656 no reason other than routine screening could be found for doing the test. However, only 86 patients (2 percent) actually had payment denied by Medicare. Although the US Preventive Services Task Force recommends against routine screening for people between ages 75 and 84 and against any screening for those over 85, one-third of patients who were 80 or older at their initial negative screening colonoscopy had another exam within 7 years. The study authors pointed out, This is of special concern, given the increased potential for complications and decreased benefit of this examination in the very old. Repeating a colonoscopy early after a negative exam was more likely to occur when: Endoscopists doing the first colonoscopy did more than 1,200 procedures a year.The exam took place in a doctor’s office rather than a hospital or ambulatory surgical center.The patients were male.The exam took place in the Middle Atlantic or North Central regions of the United States.Patients had less than high school education. For average-risk patients without a family history of inherited colorectal cancer, the natural development of cancer from even quite large polyps is slow. Before the era of colonoscopy, doctors at the Mayo Clinic followed 226 patients who had barium enemas with advanced adenomas (over 1 cm) for 5, 10, and even 20 years. During that time only 2.5% became cancer at 5 years and 8% at 10 years. Seven out of ten cancers were found at an early stage before spreading to lymph nodes or distant sites. After analyzing their results, James Goodwin, MD, and his colleagues at the University of Texas concluded, A large proportion of Medicare patients who undergo screening colonoscopy do so more frequently than recommended. Current Medicare regulations intending to limit reimbursement for screening colonoscopy to every 10 years would not appear to be effective. SOURCE: Goodman et al., Archives of Internal Medicine, online first May 9, 2011. What This Means for Patients Although the research was done in Medicare patients over 65, there is no reason to believe that younger patients are not also being screened more often than guidelines call for. After your screening colonoscopy, be sure that you have a copy of the results that describe if adenomas (polyps) were found and what their size and description was. If you don’t understand the report, ask your doctor to explain it.Check to see if the recommendation for the next screening exam fits within the guidelines for colorectal cancer screening. If the return recommendation is sooner that guidelines call for, ask why! For people at average risk of colorectal cancer, colonoscopy screening is recommended beginning at age 50 and then every 10 years unless adenomas or cancer are found. The US Preventive Services Task Force says that elderly people between 75 and 84 should not be routinely screened for colorectal cancer and those over 85 should not be screened at all. If your older relative is getting colonoscopy recommendations that doesn’t fit the guidelines, ask why. They are at higher risk for complications from the procedure and may well not benefit from screening. But remember: Symptoms of colorectal cancer at any time — even after a negative screening colonoscopy — and at any age call for diagnostic colonoscopy.People with a family history of colorectal cancer or a personal medical history of cancer, adenomas, or inflammatory bowel disease (ulcerative colitis or Crohn’s disease) are not at average risk. They should follow screening and surveillance programs for increased and high risk, including beginning earlier than 50 and being screened more often. 35 thoughts on “Some People Getting Colonoscopy Screening Too Often” I am 57 and I had a colonoscopy done, the doctor said he found two polyps and removed them and everything was ok that I should followup In a week. 5 days after my colonoscopy I called the doctors office. The receptionist said that The doctor diagnosed me with an (UNKNOWN MEDICAL TERM), Aftrr asking her what that term meant she said they were some lesions on my Colon therefore I should schedule another color colonoocopy in one year. Does anyone know what exactly this means I am 57 and I had a colonoscopy done, the doctor said yeb emivef teo polyps and everything was okay and I should follow up In a week. 5 days after my colonoscopy I called the doctors office. The receptionist said that The doctor diagnosed me with an (UNKNOWN MEDICAL TERM), After asking her what that term meant she said they were lesions in My colon, therefore; the doctor wanted me to take a colonoscopy every year. anyone haveang I’m a 54 female who has been having a lot of stomach issues. I recently had a colonoscopy, and a 6” mm polyp was removed . The doctor who did the colonoscopy, gave a report explaining that everything looks normal, however did a biopsy to make sure everything was fine. A week later I had a bad stomach pain. I went to a different hospital, and was admitted to the hospital because my blood test showed a bad inflammation somewhere in my body. Now another doctor at the hospital is recommending for me to have another colonoscopy as soon as possible. Is this normal? Did someone else had the same experience? Two colonoscopies in less than a month? I had a Colonoscopy last year and 2 Polyps were found and they weren’t cancerous, but one was a little large and the doctor wanted me to come back in a year to make sure he got it all. Well, this year he found 2 polyps and he said that one of them was one that he missed (didn’t see because of the way it was laying) last year. After removing all said polyps, he then says that he wants to see me again next year. I am refusing to have a Colonoscopy 3 years in a row and my tests came back that none of the polyps were cancer or pre-cancerous and I am not high-risk. I am going to be getting another opinion from a different doctor, because I think this is too aggressive. how come you cant have a FIT test after a Colonoscopy Hey Regina, there’s not a general answer just b/c everyone’s case differs. Would be a great question for your GI to understand your recommended screening plan! Hi! I am almost 38 years with a family history of colon cancer. My father and paternal grandmother both have had colon cancer. Almost 3 years ago I had a colonoscopy for stomach issues and it was negative. I am now having symptoms related to colon cancer and my doctor said that since I had the colonoscopy so recently that there’s no need for another one and diagnosed me with IBS. She is wanting a stool sample which I have yet to do. My question is, should I push for another colonoscopy even if it hasn’t been 5 years, which is what I was told was the recommended wait time? During first preventive colonoscopy, two polyps were removed. During the annual physical checkup , my physician said that it has been 10 years since my last colonoscopy and i am due for another colonoscopy. During the second colonoscopy , one polyp was found and the procedure was billed as diagnostic. Is this correct? Dr’s office says since i had polyp in my first test, it was never a preventive care. My question is whya wasn’t i informed about it prior to the test? Pl. advise. Thanks My gastroenterologist said essentially the same thing. Once you have even a single polyp removed, all your future colonoscopies for the rest of your life will be coded by the doctor as “diagnositic” rather than “screening.” I don’t know yet how this will affect my ability to get a free colonoscopy every 10 years through Affordable Care Act insurance regulations since that is specifically for “screening” colonoscopies. I guess I’ll cross that bridge when I come to it. In the meantime, I have to get tested every 5 years so this one will have to be paid out of pocket since I have a $10K deductible. My dad died of colon cancer 6 years ago at 55. I was 27 the first time I had a colonoscopy due to stomach issues. In that t, they found 8 polyps and two were precancerous…I went back this January and had another one done and they found 9 polyps with 4 being precancerous. They scheduled another one 3 months later which is tomorrow. I really don’t understand why I am having to go this soon, but I’m grateful that my doctor is keeping a close eye on it. I’m praying there’s no polyps that have formed in last three months but i wonder when I’ll have to have the next one! I’m 31 and have 6 kids! Don’t enjoy prepping for these every few months!!! They also had me do genetic testing and that came back negative but they found a mutation in the cdh1 gene…but bc they don’t know if it’s harmful or harmless, I am trusting God that it’s nothing I have to worry about! I was just found to have colon cancer after colonoscopy. My three previous had polyps that eere benign. I am 65 years old. I asked for colonoscopy 2 years ago and one year ago and the doctor said I didn’t need it so it has been five and a half years since my last one. The doctor who did the colonoscopy set up I too had one two years ago or even a year ago I wouldn’t have cancer now most likely or be in such an advanced stage. Am I wrong in thinking that this could have been avoided if my doctor done what I asked him to? Hi James, We aren’t able to give direct medical advice, but it’s not easy to know how quickly a polyp develops into cancer. Many CRCs take a long time to develop which is why the typical screening interval is 10 years. However, there are cancers that develop and grow more quickly than others. If you have additional questions, please email us directly at email@example.com Just read the article above and I am wondering why my colorectal surgeon scheduled my second one at 7 years. He stated after the first one that 10 years was too long, yet mentioned no abnormalities? Hey David, thanks for the comment! We’re unable to specifically talk about personal cases via our blog, but our Answer Line associate might be able to help! Call 877-427-2111 if you’d like to chat more! I just got my first colo. and have been reading around doing research. Google “How often should I get a colonopscopy” and you get a lot of articles from organizations and docs and whatever that say 5 to 10, then 7 to 10, then just 10. Theres some on if more frequently than 10 is too soon if no polyps or if 7 is average of what people who get them actual get. Down below, some people were told wait 5 yrs but should have gone back in 3. With medical guidelines, they are based on statistical averages of people. You might be on one side or the other of the average. 7 is within the middle of what a lot of what you will read on line in 2015. Get 2nd or 3rd opinion. Unfortunately, the US doesn’t have single payor healthcare, so how often will depend more on what you can afford….which is what your insurance will pay. So check into your copay responsibility and then talk to doc about medival risk and uou will have better info to make a cost benefit decision on your life. Read down below. Some poor guys wish they had gone in 1 yr not 7. Don’t use someone else’s numbrr. Make your own decision for you. Do you have a first degree family member who had colon cancer? That would be another possible reason why your doctor wants to see you sooner than 10 years. I have had polyps the last two times. The last colonoscopy was in 2011. My Dr. says it’s now time for another colonoscopy. That would mean it will have been only 3 years between procedures. Should I refuse his advice and counsel? Hey Jeff – we will email you directly about this! Thanks! I was diagnosed with colorectal cancer at the age of 43. I was at stage III. I am 44 now and just had my last visit with my doctor. He tell me he will see me in one year and then 2 years for a colonoscopy screen. I feel that is to long. Hey Michelle, we encourage you to keep talking with your doctor to come up with a plan that is right for you. Make sure to be a partner with him and ask questions. Don’t hesitate to get a second opinion, too. If you’d like – check out some of our resources that show you what many treatment plans include – the NCCN guidelines from our resource page may especially be helpful: https://fightcolorectalcancer.org/learn-about-colorectal-cancer/resource-library/. And, if you want to talk with someone, just give our Answer Line a shout: https://fightcolorectalcancer.org/learn-about-colorectal-cancer/answer-line/ Hope that helps! Hello my family member! I want to say that this article is awesome, great written and come with approximately all vital infos. I would like to look extra posts like this . My daughter was having bowel problems age 34. They did a colonoscopy and no cancer showed. Question, whey 8 months later, after we switch Drs, did the new dr find stage 4 Rectal Cancer…? Does Cancer go from Nothing to stage 4 in only 8 months? My wife had a negative colonoscopy five years ago. History of colon cancer in a large family included a cousin and uncle. A FOBT was positive as was a colonoscopy for stage III cnacer. The article should give more information as to who is at risk and may need more frequent exams. I was told the colorectal cancer screening was paid for by medicare so how come I have to pay the hospital There is an oversight in the Affordable Care Act (ACA) that keeps Medicare for paying for polyp removal during a colonoscopy. Screening colonoscopy is a preventive service covered by Medicare without deductibles or co-pays. However, once the doctor finds and removes a polyp for biopsy the procedure is no longer “preventive” but becomes “therapeutic” and deductibles and co-pays apply. Medicare should continue to pay most of the costs of your colonoscopy with polypectomy BUT you or your supplemental insurance have to cover the rest. The hospital can’t bill you for the full cost. Call them and make sure they know you are covered by Medicare and if you have supplemental (Medigap) insurance that the copay should be covered. Fight Colorectal Cancer is working on changing the law so that this problem is resolved. You can join us by going to the Fight Colorectal Cancer advocacy site Urge Your Representative to Remove Medicare Barriers to Colorectal Cancer – Support H.R. 4120 and emailing your member of Congress. If you are on Medicare, you should NOT be billed for the full cost of a colonoscopy where polyps were removed, but you can be billed for a co-pay. This normally should not exceed $100 to $300. to ask your member of Congress to co-sponsor legislation (H.R. 4120) I am afraid of colonoscopies. I know I need one, I will be 52. I need some advise. Thank you I suggest that you contact the Fight Colorectal Cancer Answer Line at 1-877-427-2111 and talk over some of the alternatives for colorectal cancer screening and what actually happens during a colonoscopy that might make you fear it less. Although colonoscopy every ten years is an excellent screening tool because the entire colon is seen during the exam and any polyps can be removed at the same time, there are other screening methods that also will protect you. If you are willing to have your stool to be tested every year with FIT (fecal immunochemical testing), with the possibility that a positive test will need a colonoscopy follow-up, you will be protected. FIT every year is equivalent in preventing deaths from colorectal cancer as colonoscopy every ten years. There are other screening alternatives that also might provide protection from colorectal cancer, perhaps not as strong as colonoscopy but as colonoscopy pioneer Sidney Winawer, MD himself said, “The best test is the one that gets done.” So, avoiding screening because you are afraid of colonoscopy isn’t necessary. There are alternatives, and there are also ways to calm your fears by understanding what will happen during the process. My last colonoscopy was done in 2007 with a clean bill of health. Dr recomends that the last in final one in 2017. I am 75 What is your opinion. Recommendations from the US Preventive Services Task Force are not to do routine colonoscopies after 75 and not to do them at all after 85. The American College of Physicians recommends stopping screening at age 75 and not screening anyone with fewer than 10 years to live. In 2017 you’ll be 80, if my numbers are right. At that time, a discussion with your doctor would be in order about your overall health conditions and whether the risk of a colonoscopy outweighs any potential risk of colorectal cancer. Colonoscopy can be dangerous in the elderly, with the potential of the scope making a hole in the colon or bleeding. In addition, older people have more risk of dehydration or side effects from a harsh prep or problems with sedation. And, our fingers are crossed here for an easier screening method in the next five years, perhaps even a sensitive blood test. I am not a doctor, but right now my feeling is that you should not worry right now about a test five years from now. I am a stage 2 rectal cancer survivor. I can’t stress the importance of having a colonoscopy exam. My first follow up colonoscopy after cancer treatment showed one begnin polyp. Happily, my second follow up colonoscopy was negative. My insurance is inadequate and it has been very costly for me, but I am cancer free right now, too. I feel for Mike (above) $180 is a lot to shell out for the test but the cost of not doing it may be much higher. I feel lucky to live in the UK where the NHS takes care of this for you. There is even a free programme of FOB testing for over 50’s. A shame Mr Obama watered down his health reforms It is important to realize that there is a difference between screening colonoscopy for patients without symptoms or abnormal tests and diagnostic colonoscopy for people who have symptoms of colorectal cancer or have had a positive stool test (FOBT, FIT). Insurance should cover diagnostic colonoscopy , although there may be a co-pay. Medicare covers both screening and diagnostic colonoscopies. Mike and Frederick, The Fight Colorectal Cancer Answer Line Associate will be getting back to both of you with help answering your questions very soon. You have individual situations that need more specific answers. i did the home stool sample (3 bowel movements ) the Dr detected microscopic blood on ONE sample , now wants me to have colonoscopy , I was going to have one 2 years ago but though I have Blue Cross insurance appearantly they do not cover this procedure , 10 minute office visit cost me $ 180.00 out of pocket then the items for prep were going to cost another 60 , the procedure itself ws going to be over 800 I would just like to know about what the Average is , if I have to pay this out of pocket i cannot afford these prices My father died of colon cancer, as did my sister. When I lived in New Jersey I had a colonoscopy every other year. When I moved to Charlotte the doctors would only do a colonoscopy every 5 years. I didn’t make their 5 year limit. I had stage II colon cancer with surgery in 2009, and in 2011 found, despite follow-up with an oncologist every 90 days, that it had progressed to state IV. If a colonoscopy had been done every other year, this could have been avoided. Comments are closed.