Clinical Crossroads Section Editor: Margaret A. Winker, MD, Deputy Editor.
Author Affiliation: Dr Taylor is Associate Professor of Medicine, Harvard Medical School, and Senior Physician, Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Mass.
DR BURNS: Ms G is a 71-year-old woman with a past medical history of osteoporosis, mitral valve prolapse, mild rheumatoid arthritis, and hypothyroidism. She has Medicare. Ms G is trying to decide whether to undergo a colonoscopy to screen for colon cancer.
Ms G is currently feeling well and has no active medical issues. Ms G's physician has encouraged her to have a colonoscopy, but she remains reluctant to proceed for 3 reasons. First, she has had adverse reactions to anesthetic agents in the past and is concerned about a potential reaction to the agents that would be used for a colonoscopy. Second, she is concerned about needing transportation home after receiving a sedative because her husband has driving restrictions. Third, she is unsure about the importance of colonoscopy given her negative family history of colon cancer. In addition, she expressed a concern about the size of colonoscopes designed for adults. Of note, she has completed home-based fecal occult blood testing (FOBT) on a yearly to every-other-year basis, and test results have always been negative. She has never undergone flexible sigmoidoscopy.
Taylor WC. A 71-Year-Old Woman Contemplating a Screening Colonoscopy. JAMA. 2006;295(10):1161–1167. doi:10.1001/jama.295.10.1161