Sylvain Beorchia, MD

Given the rising incidence, frailty-related risks, and competing mortality, colorectal cancer (CRC) screening in adults older than 75 years has no straightforward answer, and the data increasingly support individualized shared decision-making rather than routine surveillance.

Similar to most industrialized countries, France has a high incidence of CRC . According to 2023 estimates, 47,582 new cases are diagnosed each year, with a median age at diagnosis of 71.5 years. Robust evidence suggests that fecal immunochemical testing (FIT) reduces both the incidence and mortality associated with CRC.

French guidelines recommend screening for adults aged 50-74 years; beyond that age, the risk benefit profile is considered unfavorable, justifying discontinuation of routine screening. This theoretical cutoff, however, raises important questions: Life expectancy continues to rise (80.3 years for men and 85.9 years for women), and nearly 1 in 2 CRC cases is diagnosed after age 75, with incidence steadily increasing in this age group. Furthermore, the concept of frailty, on which the relevance of screening beyond the age of 75 years depends, remains difficult to define and assess in a way that commands consensus in geriatric practice.

Currently, few data are available to guide decisions on the initiation or continuation of CRC screening in older adults while taking prior screening history into account, particularly among those who previously received a negative result before age 75.

 

Veterans Cohort

Gupta and colleagues analyzed data from the US Department of Veterans Affairs collected between 2006 and 2019 to estimate the cumulative risk for CRC, CRC-related death, and noncancer-related death among individuals who underwent colonoscopy before age 75. Among the 91,952 individuals included, who had a median age of 71 years and were predominantly men (98%), 25,538 had an adenoma detected during their most recent colonoscopy, and 66,414 did not.

By incorporating a frailty index specific to their analysis, the authors sought to identify the adults most vulnerable to complications and least likely to benefit from endoscopic surveillance.

At 10 years of follow-up, the cumulative incidence of CRC was higher among patients with adenoma than among those without adenoma (1.1% vs 0.7%; Gray’s test, P <.001), as was CRC-specific mortality (0.5% vs 0.4%; Gray’s test, P =.005).Nevertheless, these figures remained modest compared with the risk for death unrelated to CRC, which reached 46%-48% at 10 years regardless of frailty level among individuals with adenoma. Competing mortality ranged from 34% among nonfrail older patients to 82% among the most-frail older patients.

In other words, even among individuals with a history of adenoma, the risk for death from another cause substantially outweighed the risk for death from CRC. The authors concluded that adults aged ≥ 75 years could reasonably place surveillance colonoscopy lower on the list of health priorities in favor of other concerns.

LEGGI TUTTO https://www.medscape.com/viewarticle/colonoscopy-beyond-75-are-risks-outweighing-benefits-2026a1000fzw?ecd=WNL_trdalrt_pos1_ous_260521_etid8360464&uac=286300CK&impID=8360464