Colorectal cancer (CRC) screening is cost-effective in elderly patients and should continue well past age 75 for those who have not already been screened, according to an article being published in Annals of Internal Medicine.
Current CRC screening guidelines by the United States Preventive Services Task Force recommend screening with fecal occult blood testing, sigmoidoscopy, or colonoscopy from ages 50 to 75 years. The Task Force Recommends against screening after age 75 for those with an adequate screening history, but many in the medical community have interpreted that to mean that no one over the age of 75 should be screened for CRC. Researchers sought to determine up to what age elderly persons without previous CRC screening should be tested, and which test should be used at which age. Using a computer simulation, they compared screening a cohort of 10 million elderly patients between 76 and 90 years with no, moderate, and severe comorbid conditions to a cohort of adequately screened elderly persons. Each cohort had a one-time screening with colonoscopy, sigmoidoscopy, or fecal immunochemical test (FIT) and cost-effectiveness was assessed for each method.
The researchers found that in previously unscreened elderly patients with no comorbid conditions, CRC screening was effective and cost-effective up to age 86 years. Screening effectiveness and cost-effectiveness declined as comorbid conditions increased. Among the screening tools, colonoscopy as most effective and still cost-effective up to 83 years, sigmoidoscopy was indicated at age 84 years, and FIT was indicated at ages 85 and 86 years. According to the authors of an accompanying editorial, these findings have important clinical implications because colonoscopy should now be considered in every patient aged 75 and older who has not had colorectal cancer screening previously.
Article: Should Colorectal Cancer Screening Be Considered in Elderly Persons Without Previous Screening?: A Cost-Effectiveness Analysis, F. van Hees, J.D.F. Habbema, R.G. Meester, I. Lansdorp-Vogelaar, M. van Ballegooijen, and A.G. Zauber, Annals of Internal Medicine, DOI: 10.7326/M13-2263, published 2 June 2014.
American College of Physicians