Screening colonoscopy in very elderly patients

Current guidelines do not include an upper age cutoff for colorectal cancer (CRC) screening with colonoscopy. Although the prevalence of colonic neoplasia increases with age, life expectancy decreases. Thus, the benefit of screening colonoscopy in very elderly patients may be limited. We performed a cross-sectional study to compare the estimated life-years saved with screening colonoscopy in very elderly (80+ yr old) versus younger subjects (50-54 yr old).
Our results were based on 1244 patients who underwent screening colonoscopy. Despite higher prevalence of neoplasia in very elderly patients, mean extension in life expectancy was much lower in the 80+ year-old group than the 50-54 year-old group (0.13 versus 0.85 years).
In sensitivity analysis, with longer polyp lag times the mean extension in life expectancy decreased more in the elderly than the younger patients; alternatively, if we assume a smaller proportion of adenomas progress to CRC, the mean extension in life expectancy decreased less in the elderly than the younger patients. In conclusion, even though the prevalence of neoplasia increases with age, screening colonoscopy in very elderly patients (aged 80+ years) 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.

Bibliographical reference:

Lin OS et al.: "Screening colonoscopy in very elderly patients: prevalence of neoplasia and estimated impact on life expectancy", 
JAMA. 2006 May 24;295(20):2357-65

Otto Lin

Gastroenterology Section, Virginia Mason Medical Center, Seattle, USA