Practical considerations for colorectal cancer screening in older adults

Gornick, Dana; Kadakuntla, Anusri; Trovato, Alexa; Stetzer, Rebecca J.; Tadros, Micheal

doi:10.4251/wjgo.v14.i6.1086

Cited by 9 publications

(9 citation statements)

References 99 publications

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“…Another possibility is that adults with lowered life expectancy would have more contact with health systems, where physicians overwhelmingly prefer colonoscopy to other screening methods (96.8% preferred colonoscopy vs others) (25). This is particularly concerning given that complications from colonoscopies increase with worsening chronic conditions and advancing age (3–5,26).…”

Section: Discussionmentioning

confidence: 99%

“…Life expectancy, rather than chronological age, is more informative in cancer screening among older adults, including breast, cervical, and prostate cancers, to ensure screening recipients live long enough to benefit (2,6,23,24). The lack of net benefits from cancer screening among adults with limited life expectancy is widely recognized in clinical practice guidances (1,4,6,7). However, we observed no association between 10-year mortality risk and CRC screening, suggesting that in current practice, decisions and quality metrics remain anchored in chronological age (11).…”

Section: Discussionmentioning

confidence: 99%

“…The balance of screening benefits and harms becomes less favorable with advancing age, deteriorating health status, and diminishing life expectancy (2). Adverse events associated with screening (e.g., bleeding, perforation, and hospital admissions) also increase with age and among those with chronic conditions (3)(4)(5). Furthermore, few polyps will progress to symptomatic cancer in less than 10 years, contributing to overdiagnosis of CRC (5).…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, few polyps will progress to symptomatic cancer in less than 10 years, contributing to overdiagnosis of CRC (5). There is, therefore, general agreement that CRC screening is unlikely to provide net benefit for individuals with limited life expectancy (4,6). For example, the USPSTF concludes that CRC screening may provide small net benefits for adults 76-85 years and likely no benefit after 85 years (1).…”

Section: Introductionmentioning

confidence: 99%

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Colorectal Cancer Screening Receipt Does Not Differ by 10-Year Mortality Risk Among Older Adults

Liu,

Singal,

Murphy

2023

Am J Gastroenterol

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Background: Health status and life expectancy are important considerations for assessing potential benefits and harms of colorectal cancer (CRC) screening programs particularly among older adults. Methods: We examined receipt of past-year CRC screening according to predicted 10-year mortality risk among 25,888 community-dwelling adults aged 65-84 years who were not up to date with screening in the nationwide National Health Interview Survey. Ten-year mortality risk was estimated using a validated index; from the lowest to highest quintiles of the index, risk was 12%, 24%, 39%, 58%, and 79%, respectively. We also examined the proportion of screening performed among adults with life expectancy <10 years. Results: Prevalence of past-year CRC screening was 39.5%, 40.6%, 38.7%, 36.4%, and 35.4%, from the lowest to highest quintile of 10-year mortality risk. Odds of CRC screening did not differ between adults in the lowest vs. highest quintile (adjusted OR 1.05, 95% CI: 0.93-1.20). One-quarter (27.9%) of past-year CRC screening occurred in adults with life expectancy <10 years, and more than half (50.7%) of adults age 75-84 years had 10-year mortality risk ≥50% at the time of screening. In an exploratory analysis, invasive but not non-invasive screening increased as 10-year mortality risk increased (p<0.05) among adults 70-79 years. Conclusion: Past-year CRC screening does not differ by predicted 10-year mortality risk. An age-based approach to CRC screening results in under-screening of older, healthier adults and over-screening of younger adults with chronic conditions. Personalized screening with incorporation of individual life expectancy may increase the value of CRC screening programs.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Colorectal Cancer Screening Receipt Does Not Differ by 10-Year Mortality Risk Among Older Adults

Liu,

Singal,

Murphy

2023

Am J Gastroenterol

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“…The older age group is associated with greater challenges in treatment because of comorbidities and frailty, which become more frequent in the older population [ 5 ]. Studies have also observed that diagnosis may be delayed due to reduced screening, as guidelines advocate for selective screening after age 75 and discourage screening in patients older than 85 [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Presentation, Molecular Characteristics, Treatment, and Outcomes of Colorectal Cancer in Patients Older than 80 Years Old

Voutsadakis

2023

Medicina

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Background: An increasing proportion of the population of patients with cancer presents at an advanced age, increasing the challenges of successful and well-tolerated treatments. In the older spectrum of the geriatric cancer patients, those older than 80 years old, challenges are even higher because of increasing comorbidities and decreasing organ function reserves. Methods: Studies regarding colorectal cancer presentation, treatment, and prognosis in patients older than 80 years old available in the literature were evaluated and were compiled within a narrative review. Molecular attributes of colorectal cancer in the subset of patients older than 80 years old in published genomic cohorts were also reviewed and were compared with similar attributes in younger patients. Results: Characteristics of colorectal cancer in octogenarians are in many aspects similar to younger patients, but patients older than 80 years old present more often with right colon cancers. Surgical treatment of colorectal cancer in selected patients over 80 years old is feasible and should be pursued. Adjuvant chemotherapy is under-utilized in this population. Although combination chemotherapy is in most cases not advisable, monotherapy with fluoropyrimidine derivatives is feasible and efficacious. Conclusions: Outcomes of colorectal cancer patients over the age of 80 years old may be optimized with a combination of standard treatments adjusted to the individual patient’s functional status and organ reserves. Increased support for the older age group during their colorectal cancer treatment modalities would improve oncologic outcomes with decreasing adverse outcomes of therapies.

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Competitive Risk Analysis of Prognosis in Older Adults with Sigmoid Colon Adenocarcinoma: A Population-Based Study

Du,

Guo,

et al. 2024

Cancer Control

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Background The purpose of this study is to employ a competing risk model based on the Surveillance, Epidemiology, and End Results (SEER) database to identify prognostic factors for elderly individuals with sigmoid colon adenocarcinoma (SCA) and compare them with the classic Cox proportional hazards model. Methods We extracted data from elderly patients diagnosed with SCA registered in the SEER database between 2010 and 2015. Univariate analysis was conducted using cumulative incidence functions and Gray’s test, while multivariate analysis was performed using both the Fine-Gray and Cox proportional hazards models. Results Among the 10,712 eligible elderly patients diagnosed with SCA, 5595 individuals passed away: 2987 due to sigmoid colon adenocarcinoma and 2608 from other causes. The results of one-way Gray’s test showed that age, race, marital status, AJCC stage, differentiation grade, tumor size, surgical status, liver metastasis status, lung metastasis status, brain metastasis status, radiotherapy status, and chemotherapy status all affected the prognosis of SCA ( P < .05). Multivariate analysis showed that sex, age, race, marital status, and surgical status affected the prognosis of SCA ( P < .05). Multifactorial Fine-Gray analysis revealed that key factors influencing the prognosis of SCA patients include age, race, marital status, AJCC stage, grade classification, surgical status, tumor size, liver metastasis, lung metastasis, and chemotherapy status ( P < .05). Conclusion Data from the SEER database were used to more accurately estimate CIFs for sigmoid colon adenocarcinoma-specific mortality and prognostic factors using competing risk models.

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Practical considerations for colorectal cancer screening in older adults

Cited by 9 publications

References 99 publications

Colorectal Cancer Screening Receipt Does Not Differ by 10-Year Mortality Risk Among Older Adults

Colorectal Cancer Screening Receipt Does Not Differ by 10-Year Mortality Risk Among Older Adults

Presentation, Molecular Characteristics, Treatment, and Outcomes of Colorectal Cancer in Patients Older than 80 Years Old

Competitive Risk Analysis of Prognosis in Older Adults with Sigmoid Colon Adenocarcinoma: A Population-Based Study

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