CRC Screening Should Be Continued in Older Patients Who Smoke, Have History of Disease

Patients who are aged more than 75 years should undergo screening for colorectal cancer (CRC) if they had a history of CRC, were smokers, or are aged 85 years and older, according to a study published in JGH Open.¹ These groups were more likely to have advanced neoplasia found during colonoscopies.

The incidence of CRC is known to increase with older age. Current guidelines recommend screening through the age of 75, but it is unclear if this is an appropriate time to stop screening. Both the American Society for Gastrointestinal Endoscopy (ASGE)² and the European Society of Gastrointestinal Endoscopy provide guidelines that either the utility of screening should be taken on a case-by-case basis in those aged 75 years and older or should be finished altogether by age 80, respectively.

This study aimed to evaluate what the incidence of CRC and advanced adenoma was during colonoscopies in patients aged 75 years and older who were otherwise asymptomatic.¹

Doctor addressing cancer in older patient | Image credit: Peakstock - stock.adobe.com

All participants were enrolled in the South Australian Southern Cooperative Program for the Prevention of Colorectal Cancer. The study was retrospective and analyzed data of patients aged 75 years and older from 2015 to 2020. Data were included if there were colonoscopy results for surveillance reasons in an asymptomatic patient. Colonoscopies were excluded if they were performed for any other reason or if the participant did not have proper preparation.

Age, sex, body mass index, and socioeconomic status were recorded for all participants. Participants were split into 3 groups by age: ages 75 to 79.9 years, 80 to 84.9 years, and more than 85 years. Other factors recorded included smoking status, comorbidities, and a history of alcohol consumption. Outcomes were also categorized as either CRC or advanced adenoma.

A total of 698 colonoscopies from 574 participants were included in the study, all of which were performed on participants aged 75 years and older. The colonoscopies were performed more often in men (55.6%) and the overall cohort had a median (IQR) age of 78.5 (76.6-80.8) years. Only 4.3% of colonoscopies were performed in those aged 85 years or older. CRC was diagnosed in 10% of the participants and advanced adenoma was found in 39.1%.

The overall incidence of CRC was 1.58% in those getting surveillance colonoscopies, where participants with a prior history of CRC had a higher incidence compared with those without prior CRC (4.2% vs 0.5%). Participants who were aged 85 years or older (IRR, 5.76; 95% CI, 1.59-20.86), had a history of CRC (IRR, 5.88; 95% CI, 1.51-22.85), or were active smokers (IRR, 4.89; 95% CI, 1.00-24.39) were more likely to have a diagnosis of CRC after a colonoscopy for surveillance. Age of 85 years or older (IRR, 7.69; 95% CI, 1.51-39.22) and actively smoking (IRR, 11.60; 95% CI, 1.53-87.79) were still found to have a higher association with a diagnosis of CRC after limiting the cohort to only those who had a history of CRC.

Advanced adenoma was found in 37.85% of participants. Advanced adenoma was associated with having advanced adenoma at a previous colonoscopy (IRR, 1.61; 95% CI, 1.31-1.97) and the presence of polypharmacy (IRR, 1.24; 95% CI, 1.01-1.53).

There were some limitations to the study, one being that it only included those who were at higher risk of CRC, which means that there were likely reasons why doctors felt surveillance would be necessary after 75 years of age. Colonoscopies done for reasons other than surveillance were not included. Data on smoking status and alcohol intake were not always available. Additionally, the final year of the audit could have been affected by the COVID-19 pandemic.

The researchers concluded that there was a significant incidence of advanced neoplasia in patients aged 75 years and older who had a colonoscopy for surveillance reasons. This indicates that colonoscopies should be considered for this population if they have a previous history of CRC, are current smokers, or are aged 85 years and older, as it could help in preventing incidences of cancer in this population.

References

1. Agaciak M, Wassie MM, Simpson K, et al. Surveillance colonoscopy findings in asymptomatic participants over 75 years of age. JGH Open. 2024;8:e13071. doi:10.1002/jgh3.13071
2. Patel SG, May FP, Anderson JC, et al. Updates on age to start and stop colorectal cancer screening: recommendations from the U.S. Multi-Society Task Force on Colorectal Cancer. Gastrointest Endosc. 2022;95(1):1-15. doi:10.1016/j.gie.2021.06.012