Do you need a colonoscopy after 75?

I am a little bit “north” of 75 and was told by my gastroenterologist last year that I no longer needed to have a routine colonoscopy. I was a bit surprised and quite relieved because it was never my favorite procedure to undergo.

“We encounter this question of when to stop doing a routine colonoscopy all the time,” said Frederick Ruymann, MD, FACG, FASGE, a gastroenterologist with Cape Cod Healthcare Gastroenterology. “It is an important question because there is a risk of perforation of the colon in about one in 1,000 to 2,000 patients when doing a colonoscopy in an older patient.”

In 2021, the U.S. Preventive Services Task Force published new guidelines stating clinicians should selectively offer screening for colorectal cancer in adults aged 76 to 85 years. The Task Force stated that the evidence indicates the net benefit of screening persons in this age group is small. They further recommend patients and clinicians should consider the patient's overall health, prior screening history and preferences.

When Dr. Ruymann has a conversation with a patient over age 75 about the risks vs. benefits of having a colonoscopy, he takes into consideration the general health of the patient, their history of colon polyps or colon cancer and their physiological (biological) age.

There are many 75-year-olds who have the physiology of a 55-year-old and there are others who have the physiology of an 85-year-old, Dr. Ruymann said. “That is why I am not guided by chronological age but by physiologic age, which is an important distinction.”

When to See a Doctor

Once the decision is made not to pursue a routine colonoscopy going forward, Dr. Ruymann explained the changes or symptoms the patient needs to watch for that would indicate the need for further conversation with their primary care physician (PCP) or gastroenterologist for possible testing. They include:

• Blood in the stool, whether it is fresh or found through testing (Cologuard or FIT tests)
• Abdominal pain
• Change in their bowel habits
• Change in stool caliber (size and diameter of the stool)
• Unexplained weight loss
• New onset of anemia or iron deficiency.

The patient also has an option to do a test using Cologuard or Fecal Immunochemical Test (FIT), said Dr. Ruymann. These are by prescription only, so they would need to contact their PCP.

“Keep an eye out for the signs and symptoms and if anything comes up, it is time for reevaluation and a discussion with your PCP or gastroenterologist about where to go from here,” Dr. Ruymann said.