Should We Screen Older Adults for CRC?

Age alone is an inefficient gauge for deciding whether to offer colorectal cancer (CRC) screening to older patients, advise the authors of a review article published in the World Journal of Gastrointestinal Oncology.

“Life and health expectancy should be used to inform cancer screening guidelines to ensure that patients live long enough to benefit from early detection,” wrote corresponding author Micheal Tadros, FACG, MD, and coauthors from Albany Medical Center, Albany, New York.

To avoid screening underuse in some older adults and overuse in others, the review piece — whose authors include a gastroenterologist and a geriatrician — offers a practical approach for CRC screening in the population. Because subjective estimates of life expectancy can be inaccurate, the approach recommends the use of tools, such as the Charlson Comorbidity Index, Clinical Frailty Score, and Mini-Cog to evaluate comorbidity, frailty, and cognitive status in a patient. Screening history and previous colonoscopy findings are also key considerations, as is patient preference.

“Despite some of the risks that colonoscopy poses in older patients, the continuation of screening endoscopy among many adults older than 75 years prevents colorectal cancer incidence and death,” the authors note, “especially among those who do not have significant comorbidities.”

Older patients who are fit can fare just as well as younger patients during CRC treatment, studies show, thanks in part to advances in laparoscopic surgical techniques and adjuvant therapies. To minimize risks in older patients, the review article recommends medication review, coordination with prescribers, patient education about bowel preparation, sedation adjustment, and endoscopic techniques that reduce the risk of bleeding.

“Altogether, this review emphasizes the importance of patient assessment, with chronological age being just one aspect of that evaluation,” the authors wrote, “and highlights important considerations for colorectal cancer screening in older patients that age-based screening guidance may overlook.”

Reference:
Gornick D, Kadakuntla A, Trovato A, Stetzer R, Tadros M. Practical considerations for colorectal cancer screening in older adults. World J Gastrointest Oncol. 2022;14(6):1086-1102. doi:10.4251/wjgo.v14.i6.1086