The prevalence of colonic neoplasia increases with age, however, life expectancy decreases.
Current guidelines do not include an upper age cutoff for colorectal cancer screening with colonoscopy.
Thus, the benefit of screening colonoscopy in very elderly patients may be limited.
Dr Otto Lin and colleagues therefore compared estimated life-years saved with screening colonoscopy in very elderly vs younger persons.
The investigators conducted a cross-sectional study among 1244 asymptomatic individuals in 3 age groups who underwent screening colonoscopy.
|Potential benefits and risks should be considered when screening the very elderly|
|Journal of the American Medical Association|
The team included 1034 subjects aged 50 to 54 years, 147 that were aged 75 to 79 years, and a further 63 patients aged 80 or more.
The investigative team's main outcomes were prevalence of various types of colon neoplasia, and estimated gain in life expectancy.
The team also assessed life expectancy during polyp lag time, and life expectancy after colorectal cancer diagnosis.
The investigators then compared mean gain in life expectancy across the 3 groups.
Life expectancy and mortality data were derived from life tables, previous studies, and national databases.
The investigators found that prevalence of neoplasia was 14% in the 50- to 54-year-old group.
The prevalence of neoplasia was 27% in the 75- to 79-year-old group, and 29% in the group aged 80 years or older.
Despite the higher prevalence of neoplasia in elderly patients, mean extension in life expectancy was much lower in the group aged 80 years or older.
In sensitivity analysis, the team noted that longer polyp lag times decreased the mean extension in life expectancy more in the elderly than in the younger patients.
Alternatively, if it was assumed that a smaller proportion of adenomas progress to colorectal cancer, the mean extension in life expectancy decreased less in the elderly.
Dr Lin's team commented, “Even though prevalence of neoplasia increases with age, screening colonoscopy in very elderly persons results in only 15% of the expected gain in life expectancy in younger patients.”
“Screening colonoscopy in very elderly patients should be performed only after careful consideration of potential benefits, risks, and patient preferences.”