Patients’ histories and circumstances can alter medical testing guidelines
Doctors often note that medicine is as much an art as it is a science, and that’s certainly true when it comes to medical screenings.
Take the reader who wonders why his doctor wants him to have a colonoscopy, even though it’s been just seven years since his last one at which, he says, “everything was fine.” And, he writes that if he does need a screening, he’d prefer having the noninvasive stool test approved last year rather than the more intrusive colonoscopy.
Normally, another colonoscopy wouldn’t be required for three more years, he adds, asking whether it’s “about the money involved?”
Dr. Nicholas Tibaldi, chief of gastroenterology for Southwest Medical Associates, can’t comment on the patient’s specific circumstances. But he does note that medical screening guidelines are just that: general guidelines that a physician can, and often will, alter for individual patients.
Tibaldi notes that physicians may use a variety of procedures to screen for colon cancer — including colonoscopy, fecal occult blood tests and flexible sigmoidoscopy — and that some are best employed in conjunction with others.
But each method has its own advantages and disadvantages. Colonoscopy, for example, “definitely is the most sensitive for finding a problem, and it allows you to actually treat the problem in one step,” Tibaldi says, even if a patient may dislike the bowl prep procedure the method requires.
Similarly, a fecal occult blood test is less invasive but has limitations versus a colonoscopy. So does sigmoidoscopy, which only directly examines part of the colon and usually is used in conjunction with a fecal occult blood test.
Meanwhile, guidelines call for regular colonoscopies beginning at age 50 and then every 10 years. But, Tibaldi says, “that changes with family history or if you have certain conditions like inflammatory bowel disease.”
So, he says, the general guidelines patients can find on the Internet aren’t hard-and-fast rules but, rather, general guides that will vary with each patient both in terms of the most appropriate test to do and how often a particular test should be done.
“My recommendations are always going to be based on what is best for patient care,” Tibaldi says. “Several factors can play a part in that. The patient’s age, family history, symptoms and other factors may come into play, too.
“The guidelines are meant to do just that: to guide you, and not necessarily to say, ‘This is what needs to be done every time and with every patient.’ ”
The more important takeaway: Don’t neglect getting screened. Colon cancer is “one of the most common cancers in both men and women and one of the few cancers that actually can be prevented,” Tibaldi says.
