Colonoscopy common, riskier in those with life expectancy of less than 10 years
A study of patients undergoing screening colonoscopy after age 75 years found that relatively few cancers were found and treated and that the risk of adverse events requiring hospitalization was high and rose with age.
Many patients who undergo colonoscopy after age 75 years have a life expectancy of less than 10 years, and cancers are rarely found in these cases, according to a recent study.
The cross-sectional study looked at use of outpatient screening colonoscopy among asymptomatic patients older than age 75 years from January 2009 to January 2022 in an integrated health system. Patients who had had a colonoscopy within the previous five years or a history of inflammatory bowel disease or colorectal cancer were excluded. Results were published by JAMA Internal Medicine on April 3.
The study included 7,067 patients (median age, 78 years; 56% women) with an average of two comorbidities (taken from a select group of comorbidities). Overall, 30% of the colonoscopies performed in the study population were in patients with a life expectancy of less than 10 years. That proportion increased with age, as did the risk of an adverse event requiring hospitalization. The rate of such events within 10 days of colonoscopy was 13.58 per 1,000 patients. The rate of advanced neoplasia detected during colonoscopy ranged from 5.4% among those ages 76 to 80 years to 6.2% in those ages 81 to 85 years and 9.5% among patients older than age 85 years (P=0.02). Only 15 patients (0.2%) had invasive adenocarcinoma, which was treated in one of the nine patients with a life expectancy of less than 10 years and in four out of the six with longer life expectancies.
“The USPSTF [U.S. Preventive Services Task Force] currently recommends individualized colon cancer screening for people older than 75 years but does not stipulate how the practice might be implemented,” said the study authors. “We found that physicians often ignored life expectancy and offered screening to a large number of patients with a life expectancy of fewer than 10 years, particularly in patients older than 80 years.” They acknowledged that conversations about discontinuing screening based on life expectancy can be difficult but highlighted the frequency of complications and unlikelihood that screening will increase life expectancy as reasons to engage in them.
Limitations include that it was a study from one health system, which could limit generalizability, and that no data were collected on the specialty of the physicians ordering the screening colonoscopy or patient preferences regarding screening.