Colon Cancer Tests after 75 May Benefit Some

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Colon Cancer Tests after 75 May Benefit Some

News Review from Harvard Medical School

June 3, 2014

News Review From Harvard Medical School -- Colon Cancer Tests after 75 May Benefit Some

Current guidelines suggest halting colon-cancer screening at age 75 for people who have been screened regularly. But a new study finds that it may be worthwhile, even as late as 86, for those who have never been tested before. The study was based on a computer model. It looked at risks and benefits of screening for a simulated group of people. The model projected what would happen if they were screened for colon cancer for the first time at different ages, from 76 to 90. Researchers concluded that screening would be worthwhile and cost-effective up to age 83 for colonoscopy, 84 for sigmoidoscopy and 86 for fecal occult blood tests. These conclusions apply to healthy seniors. Those with moderate or severe health conditions would benefit only into their late 70s or early 80s. The gains of life from screening would be small, however. For a healthy person age 76, colonoscopy would prolong life by an average of 36 days, a study author told HealthDay News. The journal Annals of Internal Medicine published the study June 3.

 

By Lori Wiviott Tishler, M.D.
Harvard Medical School

 

What Is the Doctor's Reaction?

I often talk with older patients about screening tests, such as colonoscopies and mammograms. These decisions -- at any age -- should be personal and individual. For patients under the age of 76, we have data to help guide our patients in their decision-making. But there is little good information for people 76 and older.

The authors used a computer model to evaluate screening for colorectal cancer in people ages 76 to 90 who had never had a screening test before. 

The model divided people into three groups based on their overall health. Researchers looked at the three known effective methods:

  • Colonoscopy, which uses a tube with a camera inserted into the colon
  • Flexible sigmoidoscopy, a similar but less involved procedure that does not require anesthesia
  • Fecal occult blood testing, a non-invasive procedure

The results surprised me. Doctors and patients often think that the risks of a test, especially one that is invasive, might outweigh the benefits in seniors.

These truths may hold for many patients. However, it turns out that screening is effective for many seniors who have not been screened in the past.

The study looked at both the cost-effectiveness and the overall effectiveness of screening. Effectiveness was defined as an overall gain in years of life, adjusted for quality of life. This chart summarizes the results.

First-Time Colorectal Cancer Screening
For Adults Over Age 75

Health Status
Effectiveness of Testing
Test Options
Healthy seniors
Effective until age 86
  • Colonoscopy until 83
  • Sigmoidoscopy until 84
  • Fecal testing until 86
Seniors with moderate conditions
Effective until age 83
  • Colonoscopy until 80
  • Sigmoidoscopy until 81
  • Fecal tests until 83
Seniors with severe conditions
Effective until age 80
  • Colonoscopy until 77
  • Sigmoidoscopy until 78
  • Fecal tests until 80

 

I will use these study results the next time I discuss colon cancer screening with an older person who has not yet had any screening. These findings will help guide us toward an answer that is safe, helpful and effective.

 

What Changes Can I Make Now?

Current advice suggests that colon-cancer screening can save lives for people with average risk who are between 50 and 75 years old. Those at average risk of colon cancer are advised to have:

  • Colonoscopy every 10 years OR
  • Sigmoidoscopy every 5 years OR
  • Fecal occult blood test every year 

If you have personal or family history of colon cancer or colon polyps, the advice is different. Discuss this with your doctor. People with family histories of colon cancer may need to start screening at a younger age as well.

If you are 76 or older and have never had colon cancer testing, discuss the results from this study with your doctor. They might help the two of you decide on the best test method for you. If you are 76 or older and have had previous screening tests, then you and your doctor should continue to decide about further screening based on your health and the risk of the test.

 

What Can I Expect Looking to the Future?

I am thrilled to see research that takes into account the benefit of screening for our oldest patients.  These are thorny questions. The right answers are not necessarily obvious. I also will hope to see less invasive testing for colon cancer that may change the calculation of risk and benefit even more.

Last updated June 03, 2014


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