CRC rarely found in older adults at surveillance colonoscopy regardless of polyp history
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Key takeaways:
- Detection of CRC and advanced neoplasia was 0.3% and 12%, respectively, during surveillance among older adults.
- Yields were higher with prior advanced adenoma but did not increase significantly with age.
Detection of colorectal cancer was “rare” at surveillance colonoscopy among patients aged 70 to 85 years, and although detection of advanced neoplasia was higher, overall yields did not increase significantly with age, researchers reported.
“Current guidelines do not specify an age at which surveillance is unlikely to be of substantial benefit and could be stopped,” Jeffrey K. Lee, MD, MPH, attending gastroenterologist and research scientist at Kaiser Permanente San Francisco, told Healio. “Given the increasing aging population in the United States and that over 5.5 million adults older than 75 years will undergo surveillance annually by 2024, estimating the yield of surveillance colonoscopy is important for understanding the balance between potential benefits and known risks of colonoscopy with advancing age.”
In a population-based, cross-sectional study, Lee and colleagues enrolled 9,601 patients (60.5% men; 68.9% white) who underwent surveillance colonoscopy at a large, community-based health care system between January 2017 and December 2019. Of 9,740 colonoscopies, 58.9% were performed in patients aged 70 to 74 years, 33.1% in those aged 75 to 79 years and 8% in those aged 80 to 85 years.
Studied outcomes included surveillance colonoscopy yields of CRC, advanced adenoma and advanced neoplasia overall, by age group and prior adenoma finding. All patients had an adenoma detected within the previous 12 months or more. The median time interval between index and surveillance colonoscopy was 4.9 years, and advanced adenomas were detected in 23.7% of index procedures.
According to results, researchers identified CRC in 0.3% of surveillance colonoscopies, advanced adenoma in 11.7% and advanced neoplasia in 12%. The colonoscopy yields “did not increase significantly” with age, with CRC found in 0.2% of those aged 70 to 74, 0.4% in of those aged 75 to 79 and 0.4% in of those aged 80 to 85 years, with similar reports for advanced adenoma (11.8%, 11.3% and 12.6%) and advanced neoplasia (12%, 11.7% and 13%).
Compared with patients who had prior nonadvanced adenoma, those with prior advanced adenoma had “significantly higher yields” of advanced neoplasia (16.5% vs. 10.6%) and CRC (0.5% vs. 0.2%), although yields did not increase with age.
Factors linked with the detection of advanced neoplasia at surveillance colonoscopy were prior advanced adenoma (adjusted OR = 1.65; 95% CI, 1.44-1.88), BMI of at least 30 vs. less than 25 (aOR = 1.21; 95% CI, 1.03-1.44) and a history of smoking tobacco (aOR = 1.14; 95% CI, 1.01-1.3). Conversely, Asian or Pacific Islander race was inversely associated with advanced neoplasia (aOR = 0.81; 95% CI, 0.67-0.99) compared with white race.
“With current guidelines offering no specific age at which to stop surveillance colonoscopy, our study findings can inform clinicians and older patients regarding the potential benefits, or lack of benefits, of continuing with post-polypectomy surveillance in the context of the life expectancy of the patient and weighed against the rare but known harms of colonoscopy, which increase with advancing age and comorbidities,” Lee told Healio.
“Although our study was able to determine what the yield of surveillance colonoscopy would be among older adults, more research is needed on whether surveillance colonoscopy is beneficial in reducing overall and colorectal cancer-related mortality among older adults with a prior history of polyps.”
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