Benefits of screening colonoscopy in very elderly may be limited

Even though the prevalence of colon tumors increases with age, screening colonoscopy in patients over 80 years of age results in smaller gains in life expectancy, compared to younger patients, according to a study in the May 24/31 issue of JAMA.

Current guidelines recommend colorectal cancer (CRC) screening for all patients 50 years or older, but do not specify an age limit above which screening is not recommended. The number of screening colonoscopies in elderly U.S. patients has increased dramatically since Medicare coverage was approved in 2001, according to background information in the article. However, some clinicians may have concerns with regard to screening extremely elderly patients, especially when an invasive procedure such as colonoscopy is used. Colonoscopy in very elderly patients is associated with lower procedural completion rates and possibly higher complication rates. In addition, very elderly patients have shorter life expectancies, potentially limiting the benefits of screening procedures. Decisions concerning undergoing a colonoscopy are being based on limited data regarding its impact on life expectancy.

Otto S. Lin, M.D., M.Sc., of Virginia Mason Medical Center, Seattle, and colleagues conducted a study to estimate the average extension in life expectancy in very elderly vs. younger patients undergoing screening colonoscopy. The study included 1,244 asymptomatic individuals in 3 age groups (50 to 54 years, n = 1,034; 75 to 79 years, n = 149; and 80 years and older, n = 63) who underwent screening colonoscopy.

The researchers found that the prevalence of colon neoplasia increased with age. Participants aged 80 years or older had a significantly higher prevalence of advanced neoplasia than the 50- to 54-year-old group (14 percent vs. 3.2 percent). Baseline average life expectancy was lower in the 2 older age groups vs. the 50- to 54-year-old group. Because of this, despite the higher prevalence of advanced neoplasia

Contact: Kim Davis
JAMA and Archives Journals

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