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Colorectal cancer screening in elderly persons without previous screening

This month's Annals of Internal Medicine evaluates whether colorectal cancer screening should be considered in elderly persons without previous screening.

News image

The U.S. Preventive Services Task Force recommends against routine screening for colorectal cancer (CRC) in adequately screened persons older than 75 years but does not address the appropriateness of screening in elderly persons without previous screening.

Dr Frank van Hees and colleagues determined at what ages CRC screening should be considered in unscreened elderly persons and to determine which test is indicated at each age.

The team performed a microsimulation modeling study of observational and experimental studies.

The team evaluated Unscreened persons aged 76 to 90 years with no, moderate, and severe comorbid conditions.

In unscreened persons with moderate comorbid conditions, screening was cost-effective up to age 83 years
Annals of Internal Medicine

The research team assessed one-time colonoscopy, sigmoidoscopy, or fecal immunochemical test (FIT) screening.

The team's outcome measures included quality-adjusted life-years gained, costs, and costs per quality-adjusted life-year gained.

In unscreened elderly persons with no comorbid conditions, CRC screening was cost-effective up to age 86 years.

Screening with colonoscopy was indicated up to age 83 years, sigmoidoscopy was indicated at age 84 years, and FIT was indicated at ages 85 and 86 years.

In unscreened persons with moderate comorbid conditions, screening was cost-effective up to age 83 years.

The team observed that in unscreened persons with severe comorbid conditions, screening was cost-effective up to age 80 years.

Results were most sensitive to assuming a lower willingness to pay per quality-adjusted life-year gained.

Dr van Hees' team conlcudes, "In unscreened elderly persons CRC screening should be considered well beyond age 75 years."

"A colonoscopy is indicated at most ages."

Ann Intern Med 2014;160(11):750-759
09 June 2014

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