In patients with limited life expectancy, the risks of colorectal cancer screening may outweigh the benefits.
Dr Cynthia Ko and Dr Sonnenberg quantified risks and benefits of different screening strategies in elderly patients with varying life expectancies.
The research team examined risks and benefits of screening in patients aged 70 to 94 years with differing health status using 3 strategies.
The 3 strategies included annual fecal occult blood tests, flexible sigmoidoscopy every 5 years, or colonoscopy every 10 years.
We compared the number needed to screen to prevent one cancer-related death.
The team also evaluated the number needed to encounter one screening-related complication for different strategies.
|Screening 42 healthy men aged 70 to 74 years with colonoscopy would prevent 1 cancer-related death|
The potential benefit from screening varied widely with age, life expectancy, and screening modality.
The researchers found that 1 cancer-related death would be prevented by screening 42 healthy men aged 70 to 74 years with colonoscopy.
Screening 178 healthy women aged 70 to 74 years with fecal occult blood tests would also prevent 1 cancer-related death.
The research team observed that 1 cancer-related death would be prevented by screening 431 women aged 75 to 79 years in poor health with colonoscopy.
In addition, the team noted that screening 945 men aged 80 to 84 years in average health with fecal occult blood tests would prevent 1 cancer-related death.
Colonoscopy screening had the greatest benefit but the highest risk of complications.
The potential for screening-related complications was greater than the estimated benefit in some population subgroups aged 70 years and older.
The researchers observed that at all ages and life expectancies, the reduction in mortality from screening outweighed the risk of colonoscopy-related death.
Dr Ko and colleague commented, “The potential benefits and risks of screening vary in elderly patients of different life expectancies.”
“For any individual patient, the potential for harm from screening must be weighed against the likelihood of benefit, especially with shorter life expectancy.”