May 2023
Use and outcomes of screening colonoscopy in people older than 75

Many screening colonoscopies are done in patients with limited life expectancy.

Because benefits of colorectal cancer screening take 10 to 15 years to accrue, screening is not recommended for people with life expectancy less than 10 years; thus, the US Preventive Services Task Force recommends individualised screening from age 76 years through 85 years (JAMA 2021; 325: 1965-1977, 1978- 1998). In this study from the Cleveland Clinic, researchers determined the number and outcomes of screening colonoscopies performed on 7067 older patients (age, 75 years or older; median age, 78 years).

  • The following findings were notable. The proportions of colonoscopies performed on patients with life expectancy less than 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 years, respectively.
  • Detection of advanced adenomas also increased with age – from 5.4% among patients who were 76 to 80 years, to almost 10% among patients older than 85 years. However, of 15 identified invasive cancers, nine were in patients with life expectancy less than 10 years, of whom only one patient received active treatment.
  • Adverse events within 10 days after colonoscopy increased with age, and patients with life expectancy less than 10 years had twice the rate of adverse events as did those with longer life expectancy.

Comment: Patients older than 75 years 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.

Paul S. Mueller, MD, MPH, FACP, Regional Vice President – Southwest Wisconsin, Mayo Clinic Health System, La Crosse; Professor of Medicine and Biomedical Ethics, Mayo Clinic College of Medicine and Science, Rochester, USA.

El Halabi J, et al. Frequency of use and outcomes of colonoscopy in individuals older than 75 years. JAMA Intern Med 2023 Apr 3; e-pub (https://doi. org/10.1001/jamainternmed.2023.0435).

This summary is taken from the following Journal Watch titles: General Medicine, Oncology and Hematology, Ambulatory Medicine, Gastroenterology.

JAMA Intern Med