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Use and Outcomes of Screening Colonoscopy in People Older Than 75
Because benefits of colorectal cancer screening take 10 to 15 years to accrue, screening is not recommended for people with life expectancy <10 years; thus, the U.S. Preventive Services Task Force recommends individualized screening from age 76 through 85 (NEJM JW Gen Med Jun 15 2021 and JAMA 2021; 325:1965, 1978). In this study from the Cleveland Clinic, researchers determined the number and outcomes of screening colonoscopies performed on 7067 older patients (age, ≥75; median age, 78).
The following findings were notable:
- The proportions of colonoscopies performed on patients with life expectancy <10 years (based on comorbid conditions) were 30%, 71%, and 100% for patients who were 76 to 80, 81 to 85, and older than 85, respectively.
- Detection of advanced adenomas also increased with age — from 5.4% among patients who were 76 to 80, to almost 10% among patients older than 85. However, of 15 identified invasive cancers, 9 were in patients with life expectancy <10 years, of whom only 1 patient received active treatment.
- Adverse events within 10 days after colonoscopy increased with age, and patients with life expectancy <10 years had twice the rate of adverse events as did those with longer life expectancy.
Patients older than 75 with limited life expectancy often undergo screening colonoscopies — counter to guidelines. Screening colonoscopies in these patients yield few cancer diagnoses and are associated with excess risk for adverse events. The authors call for tools that clinicians can use to estimate life expectancy and improve appropriateness of referrals.
El Halabi J et al.
Title: Frequency of use and outcomes of colonoscopy in individuals older than 75 years.
Source: JAMA Intern Med 2023 Apr 3; [e-pub]. (Abstract/FREE Full Text)