Risk of Colorectal Cancer and Colorectal Cancer Mortality Beginning Ten Years after a Negative Colonoscopy, among Screen-Eligible Adults 76 to 85 Years Old

Abstract

Background: Few empirical data are available to inform older adults’ decisions about whether to screen or continue screening for colorectal cancer (CRC) based on their prior history of screening, particularly among individuals with a prior negative exam. Methods: Using a retrospective cohort of older adults receiving healthcare at three Kaiser Permanente integrated healthcare systems in Northern California (KPNC), Southern California (KPSC), and Washington (KPWA), we estimated the cumulative risk of CRC incidence and mortality among older adults who had a negative colonoscopy ten years earlier, accounting for death from other causes. Results: Screen-eligible adults aged 76-85 years who had a negative colonoscopy ten years earlier were found to be at a low risk of CRC diagnosis, with a cumulative incidence of 0.39% (95% CI: 0.31-0.48%) at two years that increased to 1.29% (95% CI: 1.02-1.61%) at eight years. Cumulative mortality from CRC was 0.04% (95% CI: 0.02-0.08%) at two years and 0.46% (95% CI: 0.30-0.70%) at eight years. Conclusions: These low estimates of cumulative CRC incidence and mortality occurred in the context of much higher risk of death from other causes. Impact: Knowledge of these results could bear on older adults’ decision to undergo or not undergo further CRC screening, including choice of modality, should they decide to continue screening.

Surveillance colonoscopy findings in asymptomatic participants over 75 years of age

“…Exact procedural risk and overall prognosis needs to be considered in these individuals when making decision on continuing surveillance with the colonoscopy. There is relative variability in the health and life expectancy of older people, 15 , 40 and it is therefore not recommended for age to be a solitary deciding factor in surveillance decisions. 26 , 27 , 28 , 31 , 41 Objective consideration of these factors, 42 along with patient choice, should be incorporated into decision making regarding ongoing surveillance.…”

“…Current Australian guidelines state that surveillance will not benefit most people over 75 years, instead advising individualized clinical recommendations 14 . Many studies assessing colonoscopy in older individuals are limited to a screening context, with a recent study supporting that the risk of mortality from other causes is greater than that from CRC 15 . Overall, there are limited data on the benefits of surveillance colonoscopy beyond the age of 75 years, particularly where other risk factors are considered.…”

“…14 Many studies assessing colonoscopy in older individuals are limited to a screening context, with a recent study supporting that the risk of mortality from other causes is greater than that from CRC. 15 Overall, there are limited data on the benefits of surveillance colonoscopy beyond the age of 75 years, particularly where other risk factors are considered. For individuals and clinicians to make informed decisions about continuing surveillance colonoscopy beyond 75 years, it is important to determine risk factors, beyond age alone, associated with the findings of CRC and advanced adenoma in this population, particularly given the increased frequency of comorbidities and procedural complications, and reduced life expectancy.…”

Oncological and surgical outcomes of radical surgery in elderly colorectal cancer patients with intestinal obstruction

“…With the increasingly severe aging of China's population, the proportion of elderly individuals with colorectal cancer is increasing (4)(5)(6). Because elderly patients are insensitive to pain and slow to respond, disease progression is more insidious and often in the advanced stages at the time of presentation.…”

“…The incidence of colorectal cancer is positively correlated with age. With the aging of the population, the proportion of elderly patients with colorectal cancer continues to increase (4)(5)(6). Elderly colorectal cancer patients often experience an insidious onset of disease, and the disease is often in the advanced stages at initial diagnosis.…”