Screening colonoscopy knows no age limit

Screening colonoscopy is beneficial even into the ninth decade of life. Results of 2 studies presented at the American College of Gastroenterology annual meeting showed a significant improvement in disease stage at diagnosis and in survival among elderly asymptomatic patients who were screened. Recognizing an average life expectancy of 9 more years for an 80-year-old patient without significant comorbidities, the investigators concluded that screening colonoscopy is beneficial at least through age 85.

In a case-control study using data from the Scripps Green Hospital in La Jolla, Calif., gastroenterology fellow, and colleagues examined the records of all patients diagnosed with pathology-proven colorectal cancer during 5 years (2000-2005). Patients were excluded if they had a history of inflammatory bowel disease, familial adenomatous polyposis, or hereditary nonpolyposis colorectal cancer.

A total of 356 patients were stratified by age (40-95 years), gender, symptomatic or asymptomatic, and early or late disease stage.

To their surprise, there was no significant difference, in detecting cancer in asymptomatic patients who were just getting screened between older patients (aged > 75) and younger patients. Regardless of age, they were able to pick up earlier cancers, which is the goal.

For asymptomatic patients, most cancers were detected at an early stage; however, in the symptomatic group, no statistical difference was found between stage of disease at diagnosis for any age-group.

The results presented did not include survival data, but they collected and analyzed such data, following patients out to 2.6 years. They haven’t found a significant difference in younger patients versus older patients, so there’s improved survival in detecting colorectal cancer at any age.

So the recommendation after the study is to continue screening, and there is no age cut-off. The investigators could not tell if screening past age 85 is beneficial because of a limited number of participants aged > 85 years.

Survival at 7 years was significantly better for asymptomatic than symptomatic patients, and for asymptomatic patients whose colorectal cancer was detected at an early stage versus a late stage. For asymptomatic individuals, survival was the same regardless of disease stage at detection. No gender differences were found.

A fellow at the University of Buffalo, NY, found similar results. Using data from the Western New York VA System, he identified 587 elderly patients who had surveillance and screening colonoscopies in 2004 and stratified them by age: 70 to 79 years and >80 years. There was no difference in the proportion of patients in both groups alive at 2.5 years after colonoscopy. Patients aged >80 years had more tubular adenomas and colon cancers detected compared with the younger group.

Survival in colorectal cancer is generally better if it is detected and treated early. Age by itself will not preclude a patient from getting continuing screening or surveillance colonoscopy, and so if a patient is relatively healthy and there is a good indication, they should get screening.

Their recommendation to primary care physicians would be to continue referring your elderly patients, those over the age of 75, for screening colonoscopies, even in asymptomatic patients.