ASK DR. H: Screening guidelines change

Q: I’m a 65-year-old woman who developed breast cancer two years ago. I had a colonoscopy five years ago, which was normal. In light of my recent breast cancer, I wanted to have another colonoscopy because I was under the impression that I’m now at greater risk of colon cancer. However, my gastroenterologist said that Medicare doesn’t consider me to be at higher risk and won’t pay for a colonoscopy until I’m 70. Is that right?  — J.L., Roswell, Ga.

A: For years, the guidelines for colon cancer screening were that if a person had a personal history of breast, ovarian or uterine cancer he or she was considered to be at increased risk of getting colorectal cancer. But recent studies have shown differing opinions on whether there really is a heightened risk.
There is not yet a consensus of opinion on this — despite the Medicare guidelines.

The following are clear risk factors for colon cancer: Age over 50; personal history of precancerous colon polyps; personal history of inflammatory bowel disease (i.e., ulcerative colitis and Crohn’s disease), but not irritable bowel syndrome; family history of colon cancer in parent or sibling; being African-American; being of Ashkenazi Jewish heritage; history of smoking; obesity; prior history of radiation to the abdomen; heavy chronic alcohol use; adult-onset diabetes; and a diet high in red meat and processed meats.

Despite the Medicare guidelines, if you’re experiencing unexplained constipation or blood in the stool, a colonoscopy would be warranted.

Dr. Mitchell Hecht is a physician specializing in internal medicine. Send questions to him at: “Ask Dr. H,” P.O. Box 767787, Roswell, GA 30076. Because of the large volume of mail received, personal replies are not possible.