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Is Colorectal Cancer Screening Indicated in Previously Unscreened Elders? — Physician’s First Watch

Medical News |
June 3, 2014

Is Colorectal Cancer Screening Indicated in Previously Unscreened Elders?

By Jamaluddin Moloo, MD, MPH

Edited by David G. Fairchild, MD, MPH, and André Sofair, MD, MPH

Screening previously unscreened elders for colorectal cancer (CRC) can be cost-effective as late as age 86, according to an Annals of Internal Medicine study.

Using modeling, researchers evaluated to what age colorectal cancer screening should be considered in unscreened, average-risk elders (age range, 76–90). Strategies included one-time colonoscopy, sigmoidoscopy, or fecal immunochemical testing (FIT).

Compared with no screening, CRC screening at age 80 prevented 4.2 (FIT) to 10.7 (colonoscopy) CRC-related deaths for every 1000 people screened. Screening was cost-effective in those without comorbid conditions until ages 83 (colonoscopy), 84 (sigmoidoscopy), and 86 (FIT). In elders with severe comorbidities, screening was cost-effective until ages 77, 78, and 80, respectively.

Nearly a quarter of people older than 75 have never undergone colorectal cancer screening. Although we shouldn't base clinical decisions solely on simulation models, this study suggests that one-time screening for CRC in people older than 75 is cost-effective and probably should be considered in elders without comorbid conditions.

Dr. Moloo is an associate editor with NEJM Journal Watch General Medicine, from which this article is adapted.

Reader Comments (3)

Ellen Lerner, BSN

1st poster makes a good point. I have a real personal problem with diagnostic tests so invasive that there is a risk such as perforation. I am in favor of more investigation to use virtual or CT colonoscopy at any age. And I am infavor of insurance companies paying for those as well. Apparently it is more effective now and the cost has got to be less. Even if a polyp shows up and it cannot be removed on the spot it is still worth it to then have it removed in another procedure. How about all those who have negative results (even cost wise) and how many of those had problems with the test? What are the statistics on how many tested are negative vs those who had polyps removed during the test? I don't know so I am asking.

Carol Vassar, MD private practice, Vermont

What is the complication rate as the patients age. How many people would have perforated bowels compared to the number who were spared colon cancer?

SHELDON BALL Physician, Geriatrics, Anvita Health

Number needed to treat vs number needed to harm seems to be frequently overlooked,

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