How often should I have a colonoscopy?

It depends on the situation and the clinical setting. There is a great deal of confusion and disinformation on this topic. People with inflammatory bowel disease of more than eight years duration and people who have had a colon cancer removed might require a surveillance colonoscopy every year. People who have had 1-2 hyperplastic polyps or adenomatous polyps may require surveillance colonoscopy at three year intervals. People who have a family history of colon cancer might require surveillance colonoscopy at five year intervals. Insurance companies and the Federal government would like to have people have colonoscopy at ten year intervals. Medicare will not pay for an elective colonoscopy done sooner than 366 days from the last colonoscopy. There are many other scenarios which dictate follow up colonoscopy at regular intervals. Whenever one reads medical articles which purport to study the cost effectiveness of certain practices, the research methodology usually asks the question "how little can be done for patients without a noticeable increase in bad results?" Such articles seem to search for the minimum amount of care that can be given, but most physicians prefer to practice above the minimally acceptable level of care. A review article published in the July 2, 2003 issue of the Journal of the American Medical Association noted that there was a trend for commercial health insurance companies and Medicare to convince people to have less frequent colonoscopy at 10 year intervals, but many more cancers and polyps were discovered if people followed a three year follow up colonoscopy schedule.