Screening endoscopy after age 75 years lowers risk for colorectal cancer incidence, death
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Screening endoscopy among otherwise healthy individuals aged older than 75 years appeared to lower the risk for colorectal cancer incidence and cancer-associated mortality, according to study results published in JAMA Oncology.
However, screening did not confer a significant survival benefit among those aged older than 75 years with cardiovascular disease, diabetes or other comorbidities, researchers noted.
“The U.S. Preventive Services Task Force lowered the recommended age to begin colorectal cancer screening from 50 years to 45 years for persons without a family history of colorectal cancer. However, its recommendation to continue to periodically screen until age 75 years, after which the decision to undergo screening can be based on an individual’s health and risk factors, remains unchanged,” Andrew T. Chan, MD, MPH, professor of medicine at Harvard Medical School and chief of the clinical and translational epidemiology unit and gastroenterologist at Massachusetts General Hospital, told Healio. “There has been little hard evidence to support or contradict the recommendation to stop routine screening at age 75 [years].”
The prospective cohort study aimed to assess the association between lower gastrointestinal tract screening endoscopy and risk for colorectal cancer incidence and cancer-associated mortality among 56,374 participants (63.2% women) in the Nurses’ Health Study between Jan. 1, 1988, and June 30, 2016, and the Health Professionals Follow-up Study between Jan. 1, 1988, and Jan. 31, 2016, who reached age 75 years during follow-up.
Results showed 661 incident colorectal cancer cases and 323 colorectal cancer-associated deaths during follow-up.
Researchers observed a 39% reduced risk for colorectal cancer incidence (multivariable HR = 0.61; 95% CI, 0.51-0.74) and a 40% reduced risk for colorectal cancer-associated mortality (HR = 0.6; 95% CI, 0.46-0.78) — regardless of screening history — among those who underwent screening endoscopy after age 75 years.
Among those underwent screening before age 75 years, screening after age 75 years appeared associated with a 33% decrease in colorectal cancer incidence (HR = 0.67; 95% CI, 0.5-0.89) and a 42% decrease in associated mortality (HR = 0.58; 95% CI, 0.38-0.87) compared with no screening after age 75 years. Those who received their first screening after age 75 years demonstrated a 49% reduction in colorectal cancer incidence (HR = 0.51; 95% CI, 0.37-0.7) and 37% reduction in associated death (HR = 0.63; 95% CI, 0.43-0.93) vs. those who never underwent screening.
However, researchers did not observe a decrease in colorectal cancer mortality among individuals who underwent screening endoscopy after age 75 years who had cardiovascular disease (HR = 1.18; 95% CI, 0.59-2.35) or other significant comorbidities (HR = 1.17; 95% CI, 0.57-2.43).
“These are the first empirical data that truly demonstrate there is value in continuing colorectal cancer screening past age 75 years for many individuals. Screening should be tailored according to individual risk factors,” Chan said. “We are looking at other opportunities to more specifically tailor screening according to risk factors other than age, as well as considering the use of alternative means of screening, such as stool-based testing.”
In an editorial accompanying the study, Nirmala Bhoo-Pathy, MD, PhD, Nur-Nadiatul-Asyikin Bujang, MD, and Chiu-Wan Ng, PhD, all researchers at University of Malaya in Kuala Lumpur, Malaysia, noted that Chan and colleagues provided the best available evidence on the association of lower endoscopy with reduced risk for colorectal cancer and mortality among older adults; however, any recommendations to continue colorectal cancer screening after age 75 years warrant a closer look through clinical and public health lenses.
“It is also important that among older adults, the chosen screening modality will be relatively easy and safe to administer, acceptable, and that early treatment of colorectal cancer will be associated with a benefit besides the requirement for the test to be readily available and affordable,” they wrote. “Older adults may also have different priorities and preferences when making health decisions that may be explained by their diminishing life expectancies, in which quality of life may take precedence to prolongation of survival. ... It is contended that colorectal cancer screening decisions beyond age 75 years should remain individualized based on patient characteristics, in agreement with the USPSTF guideline.”
For more information:
Andrew T. Chan, MD, MPH, can be reached at Harvard Medical School, 55 Fruit St., Boston, MA 02114; email: achan@mgh.harvard.edu.
References:
Bhoo-Pathy N, et al. JAMA Oncol. 2021;doi:10.1001/jamaoncol.2021.1119.
Ma W, et al. JAMA Oncol. 2021;doi:10.1001/jamaoncol.2021.1364.
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Ma W, et al. JAMA Oncol. 2021;doi:10.1001/jamaoncol.2021.1364.
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