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Colonoscopy screening in the elderly: when to stop?

Tyler Stevens1, Carol A Burke

  • 1Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.

The American Journal of Gastroenterology
|August 9, 2003
PubMed
Summary
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Colorectal cancer screening should not stop at older ages, as advanced neoplasia risk increases with age. Colonoscopies in the elderly continue to detect significant neoplasia, justifying ongoing screening.

Area of Science:

  • Gastroenterology
  • Oncology
  • Epidemiology

Background:

  • Colorectal cancer (CRC) screening guidelines recommend specific ages to initiate screening based on neoplasia risk.
  • The optimal age to discontinue CRC screening remains undetermined and should ideally align with neoplasia risk.
  • This study investigates if neoplasia prevalence decreases with age, potentially justifying cessation of colonoscopic screening.

Purpose of the Study:

  • To determine if the prevalence of neoplasia detected by colonoscopy declines in older individuals.
  • To establish evidence-based criteria for determining the appropriate age to cease colonoscopic colorectal cancer screening.

Main Methods:

  • Retrospective review of endoscopic and pathology reports for asymptomatic individuals undergoing colonoscopy (1997-2000).

Related Experiment Videos

  • Analysis included subjects screened for CRC or evaluated for abdominal pain/bowel habit changes.
  • Multivariate logistic regression assessed the impact of age, gender, and indication on neoplasia prevalence, adenoma counts, advanced adenomas, and invasive cancers.

    • Main Results:

    • Neoplasia prevalence peaked in the seventh decade and subsequently declined (p=0.009).
    • Advanced adenomas and invasive cancers demonstrated an increasing trend with advancing age.
    • Screening colonoscopies yielded higher rates of overall neoplasia and advanced adenomas compared to symptomatic evaluations.

    Conclusions:

    • The prevalence of advanced neoplasia in the colonoscopy screening population does not decrease with age.
    • Individuals undergoing colonoscopy for screening exhibit a higher risk of neoplasia than symptomatic patients.
    • Findings do not support ceasing colonoscopic screening in the elderly due to a lack of declining advanced neoplasia yield.