Should age determine when colonoscopy screening stops?

DEAR DR. ROACH >> For many years, I have had a screening colonoscopy due to a history of colon cancer in my mother. Over the years, they have removed polyps, and some were the precancerous type. I just turned 85, and my physician assistant does not recommend another colonoscopy because of my age. I am concerned. I probably should have asked her to explain her reasoning, but I was just glad that I didn’t have to go through a colonoscopy again. What do you think about stopping colonoscopy due to age? — M.J.S. DEAR READER >> Age is only one factor to consider when deciding whether to recommend a screening colonoscopy. The individual’s other risk factors (including family history and the number and type of previous polyps removed) need to be taken into account, as do any medical conditions the person has that make the colonoscopy more risky and less useful because of competing risks from other conditions.

So, there is no absolute age cutoff for colonoscopy screening (the same is true of mammograms). However, your PA is right that expert groups, such as the U.S. Preventive Services Task Force, recommend against screening colonoscopies after age 85. In my opinion, the decision needs to be individualized — even though 85 is a reasonable time to stop, there may be some very healthy 85-yearolds I still would consider screening. For most people, though, the potential harm of a colonoscopy outweighs the benefit over age 85.

DEAR DR. ROACH >> I have taken hydrocodone for several years for back and leg pain. I was bothered by opioid-induced constipation, until I read about magnesium. I have not had a problem since, and I have told many friends, who all have had the same success. — N.B.H. DEAR READER >> People who take opiates (derived from poppy plants) and opioids (which include synthetic drugs that act in a similar way), such as hydrocodone or oxycodone, are at high risk for developing constipation. The body develops tolerance to the pain relief from these drugs, but not to the side effect of constipation.

Initial treatment for opioid-induced constipation should include plenty of water intake, regular activity and eating foods with fiber (but too much fiber can be a problem, in severe cases). If people still need help, then a medication like magnesium hydroxide or magnesium citrate is a reasonable choice. I wish I could say I had 100 percent success rate with them, but they don’t work for some and cause too many side effects in others. Other laxatives, such as polyethylene glycol (Miralax) or lactulose, are helpful in some. Some people prefer suppositories. There also are newer treatments, such as methylnaltrexone (Relistor) or lubiprostone (Amitiza).

For people taking opioids chronically, it is wise to periodically review the risks and benefits of continuing to take them. They work well for some people at reducing pain, but not at all well for others, and there’s always a risk for side effects and addiction.