Ask Dr. Roach: Follow-up colonoscopy necessary after a result of eight polyps.

DEAR DR. ROACH >> I am a 73-year-old male. This year, I had a colonoscopy. They found some small polyps and one larger polyp. All polyps tested negative for cancer. I have had two previous colonoscopies in the past 10 years. Polyps were found in each one. My gastroenterologist said I should have another colonoscopy in one year. There has been no colon cancer in my family.

As you age, is it safe to continue with a colonoscopy? I don’t feel safe having a colonoscopy every year. At what age should seniors stop having a colonoscopy? My previous gastroenterologist told me to have one in five years. I do a stool test yearly, given by my primary doctor.

— F.Q.

Dear F.Q. >> I read your reports, which showed a total of nine polyps, all “sessile” (flat, which is higher risk for development into cancer than those with a stalk), the largest being8 mm. The pathology report confirmed these as tubular adenomas, none of which had the worrisome finding of high-grade dysplasia.

The official guidelines of the American College of Gastroenterology would recommend a follow-up colonoscopy in three years. I definitely agree with that in people who are otherwise healthy. Colon cancer does definitely run in families, but at least 80% of colon cancer occurs in people with no known family history, meaning you can’t be complacent even if there isn’t any history in your family.

There is no absolute age cut-off for screening colonoscopies: Age 75 might be reasonable in someone who really doesn’t want to have another and whose previous results have all been normal, but I would be very unlikely to recommend a screening exam in a person older than85. People who have serious medical conditions outside the intestinal tract get less benefit from screening. Age 73 is not so old that I would recommend against screening in otherwise healthy people, and given that you have had eight polyps, I would definitely recommend a three-year follow-up. I don’t know why the gastroenterologist said one year, based on the reports you sent me.

DEAR DR. ROACH >> I’m 59 and have a pea-sized osteoma near the top-middle of my forehead. My grandmother had one in the same place and never got it removed. It grew to be the size of an egg!

I want to have mine removed before it gets any larger (it’s doubled in size over the last three years). What do you recommend?

— J.K.

Dear J.K. >> An osteoid osteoma is a common benign tumor of the bone. They often occur in the thigh or leg, but the forehead is not unusual and, of course, is cosmetically important.  Most do not grow, and in fact, more commonly shrink over time.

I’ve not seen an osteoma get as big as your grandmother’s, and I can understand why you would be concerned. It would be very reasonable to get an evaluation. An orthopedic surgeon with special expertise in bone tumors would be a good person to see, and some plastic surgeons also have expertise in removing bone tumors in such a way as to provide the best cosmetic result.

Contact Dr. Roach

ToYourGoodHealth@med.cornell.edu


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