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Screening colonoscopy provided modest benefit for prevention of cancer in older adults

Colonoscopy screening was mostly effective in preventing colorectal cancer in patients aged 70 years to 74 years, according to research published in the Annals of Internal Medicine.

Xabier García-Albéniz, MD, PhD, from the Harvard T.H. Chan School of Public Health, and colleagues noted these benefits decreased in patients aged 75 years and older.

“Colonoscopy is an invasive, resource-demanding procedure that requires a thorough large-bowel cleansing, and often patient sedation, and carries a risk for complications, such as bowel perforation,” the researchers wrote. “Establishing the effectiveness and safety of colonoscopy is important because less burdensome screening methods ([fecal occult blood testing] FOBT and sigmoidoscopy) are available. Currently, the U.S. Preventive Services Task Force (USPSTF) advises routine [colorectal cancer] CRC screening with any method for persons aged 50 [years] to 75 years at average CRC risk and recommends that screening decisions be individualized for those aged 76 [years] to 85 [years]. Other guidelines recommend colonoscopy screening with no upper age limit.”

García-Albéniz and colleagues conducted population-based, prospective, observational study of 1,355,692 Medicare beneficiaries to evaluate the safety and effectiveness of screening colonoscopy. The beneficiaries were all at average risk for CRC, had not received a colonoscopy in the 5 years prior to the study and used Medicare preventive services.

Results showed the 8-year risk for CRC was 2.19% (95% CI, 2% to 2.37%) in the colonoscopy group and 2.63% (95% CI, 2.56% to 2.67%) in the no-screening group for adults aged 70 years to 74 years (absolute risk difference = -0.42%; 95% CI, -0.24% to -0.63%).

The 8-year risk for CRC was 2.84% (95% CI, 2.54% to 3.13%) in the colonoscopy group and 2.97% (95% CI, 2.92% to 3.03%) in the no-screening group for adults aged 75 years to 79 years (risk difference = -0.14%; 95% CI, -0.41 to 0.16).

García-Albéniz and colleagues identified 5.6 adverse events per 1,000 individuals (95% CI, 4.4 to 6.8) in adults aged 70 years to 74 years and 10.3 adverse events per 1,000 individuals (95% CI, 8.6 to 11.1) in adults aged 75 to 69 years within 30 days of colonoscopy.

The researchers noted their results may influence patients, physicians and policymakers.

“Our findings are consistent with the USPSTF recommendations for routine screening through age 75 [years], followed by individualized decisions afterward,” García-Albéniz and colleagues concluded. “Because the ongoing trials do not include the older age groups, our study provides helpful information for benefit-risk analyses. Our estimates of the effect of screening colonoscopy on CRC incidence and complication rates in older persons are particularly important in view of current policies to increase screening uptake: The Healthy People 2020 goal is a 70% CRC screening rate.” – by Chelsea Frajerman Pardes

Disclosure: Two authors report grants from the NIH, NIH/National Cancer Institute and the Agency for Healthcare Research and Quality during the conduct of the study. Please see the full study for a complete list of all authors’ relevant financial disclosures.