Published Aug 3, 2021
New evidence shows that there are benefits to colorectal cancer screenings in individuals over the age of 75, despite government recommendations for selective screening.
A study in JAMA Oncology finds that individuals over 75 who were screened for colorectal cancer have a far lower mortality rate than those who were not screened for the disease.
“Screening endoscopy after age 75 years was associated with a reduced incidence of CRC—primarily distal colon and rectal cancer—and death from cancer, regardless of previous screening history,” notes the study.
“It’s a no brainer,” explains Dr. Heather Yeo, a colorectal surgeon at Weill Cornell in New York and a SurvivorNet medical advisor. “You don’t want have a patient in their 80s dying because they have a large obstruction that went undetected.”
The US Preventive Services Task Force currently recommends routine colorectal cancer screenings up until the age of 75. After that it is recommended that individuals consult their doctor and take into account their overall health and screening history.
Since clinical trials do not include patients over the age of 75, the evidence was gathered by analyzing the data of 56,374 participants who were enrolled in the Nurses’ Health Study and the Health Professionals Follow-up Study and had endoscopy for routine screening or had a family history of colorectal cancer. There were 661 individuals who were diagnosed with colorectal cancer and 323 who died of the disease in that group of individuals over 75.
Those who were not screened had a colorectal cancer incidence of 74.1 per 100,000 person-years and a colorectal cancer mortality of 7.9 per 100,000 person-years. (Person-years is a unit of measurement that takes a select group or all of the participants in a study and multiples that by the amount of time they are in the study.)
The study does note, however, that there may not be benefits to individuals with comorbidities such as myocardial infarction or stroke, hypertension, hypercholesterolemia, and diabetes.
Dr. Yeo explained that there is a risk for any person getting an endoscopic procedure, but said there is a less than 1% chance of a serious complication such as a perforation. And for patients who might be hesitant about endoscopy there are other options when doing colorectal screenings.
Dr. Yeo also said that she would recommend screenings up until life expectancy is less than 5 to 10 years.
Colorectal cancer is the third most common cancer affecting men and women in the United States, and the second most deadly. The American Cancer Society estimates that more than 104,000 new cases of colon cancer and more than 45,000 new cases of rectal cancer will be diagnosed in 2021.
As grim as the numbers are, the good news is that colorectal cancer is often preventable with regular screenings. In fact, research shows that as many as one third of all colon cancer deaths could be prevented with regular screenings.
The most common form of colorectal screening is a colonoscopy. In this procedure, a camera is attached to a long, thin tube which allows a doctor to look throughout your entire colon and rectum.
To prepare for a colonoscopy, you must first clean out your bowel with a strong, prescription laxative known as a “bowel prep” the night before. On the day of the procedure, you’ll typically be sedated, and the procedure generally takes between 20 minutes and an hour.
While performing a colonoscopy, the doctor is looking for polyps, which could potentially turn cancerous if not removed. If they don’t find any, you’re in the clear, and don’t need another colonoscopy for 10 years. If they find any polyps during the colonoscopy, they may be able to remove them during the procedure, though others may require surgery to be removed. Your doctor will also likely recommend more frequent screenings if any polyps are found.
Other colorectal screenings including stool tests and a sigmoidoscopy, which checks a portion of your colon. Virtual colonoscopies may also be an option for some. Your doctor can help determine the best test for you, but in general, a colonoscopy is considered the most thorough and effective at preventing and catching early-stage cancer.
The U.S. Preventive Services Task Force recommends that people between the ages of 45-75 get screened regularly for colorectal cancer, and that those older than 75 talk to their doctor about their need for screening. As rates of colon cancer have increased among younger Americans, however, some experts believe screening should begin sooner.
There are some things that may put you at higher risk for colon cancer. They include things like your age (those age 50 and older are more likely to get it) and having a family history of colon cancer. There are, however, also risk factors that you can control to some degree. For example, the following may put you at higher risk for colon cancer:
While there may be no symptoms of colon cancer in its earliest stages, there are some common warning signs, including a change in the color or shape of bowel movements, constipation, bloating, diarrhea, blood in the stool and unexplained weight loss. Anyone who experiences these symptoms, no matter their age or risk factors, should see their doctor.
After the colonoscopy, any polyps that were found will be tested further to determine if they’re cancerous. This process may take a week or more while the tissue is examined. If cancer is found, then further testing will be required to determine how advanced the cancer is and if it has spread to other organs. Additional testing may also be required to determine if the cancer is genetic in nature, as this could affect your treatment plan.
As nerve wracking as waiting for the results may be, the good news is that most polyps that are removed are noncancerous. Also, the survival rates for colon cancer caught in the early stages are good, which is yet another reason why screenings are so important.