COLORECTAL CANCER SCREENING IN THE ELDERLY – DOES INCREASED PREVALENCE NECESSITATE TIGHTER SURVEILLANCE?

Aims With age, colon cancer (CRC) prevalence rises along with an increase in the yield from screening colonoscopy and a greater risk of complications. The elderly (>75), and even more so, the very elderly (>85), are especially vulnerable. We aimed to compare CRC findings in colonoscopies that were performed following a positive Fecal Immunochemical Test/Fecal Occult Blood Test (FIT/FOBT) in both elderly and very elderly age groups with those of younger subjects.

Methods We identified colonoscopies carried out in the years 1998-2019 following positive stool test for occult blood, as a screening tool for CRC in asymptomatic individuals. A finding of malignancy was compared between two patient groups – above and below the age of 75. Furthermore, a sub-analysis was performed, for malignancy findings in FOBT/FIT positives among patients older than 85 in comparison to younger than 75.

Results The colonoscopy findings in 10,472 subjects, 40-75-year-olds (n=10,146) were compared with those of 76-110-year-olds (n=326). There was no significant difference in prevalence of CRC detection rate in the two groups following positive FIT/FOBT (2.1% vs 2.7%, p=0.47). Similar results for non-significant difference were obtained in the sub-analysis comparison of malignancy detection rate in the very elderly 0% (n=0) versus 2.1% for<75-years-old (n=18), p=0.59.

Table 1

FOBT+for age group>75, n=4,064
	Age			P value
	40-75 (n=3841)	76-85 (n=205)	>86 (n=18)
	61.3±7.4	78.55±2.5	90.6±6.4
	80 (2.1%)	6 (2.9%)	0	p=0.59

Conclusions Although the prevalence of CRC increases with age, no significant increase in the detection rate of CRC by FOBT was found in both the elderly and very elderly age groups. Screening colonoscopy in elderly patients should be performed only after careful consideration of potential benefits, risks, and patient preferences.

Publication History

Article published online:
14 April 2022