Very Elderly May Derive Less Benefit from Colonoscopy

Very Elderly May Derive Less Benefit from Colonoscopy

According to the results of a study published in the Journal of the American Medical Association, the increase in life expectancy that results from screening colonoscopy is smaller for very elderly patients than for younger patients.

Colorectal cancer is the second leading cause of cancer-related deaths in the U.S. The disease develops in the large intestine, which includes the colon (the longest part of the large intestine) and the rectum (the last several inches).

Cure rates for colorectal cancer are high when the disease is detected and treated early. Currently, it is recommended that people 50 years of age or older and those at a high risk for colorectal cancer be screened for the disease.

Screening methods include testing for blood in the stool (fecal occult blood test), flexible sigmoidoscopy, colonoscopy, and barium enema. Colorectal cancer screening can detect cancer at an early stage, and can also prevent cancer by allowing physicians to detect and remove precancerous polyps.

During a colonoscopy, a lighted instrument called a colonoscope is used to view the rectum and the entire colon. Pictures and samples of tissue (biopsies) may be taken for further evaluation by the physician. Because colonoscopy has been reported to have a higher complication rate in very elderly patients, and because very elderly patients have a shorter life expectancy than younger patients, it’s possible that very elderly patients will derive fewer benefits from screening colonoscopy than younger patients.

To compare the effect of screening colonoscopy on the life expectancy of older and younger patients, researchers conducted a study among patients in three age groups: 50-54, 75-79, and 80 or older. All patients underwent screening colonoscopy. None of the patients experienced complications from the procedure.

  • Colorectal polyps were detected more frequently in older patients: polyps were detected by colonoscopy in 14% of patients between the ages of 50 and 54, 27% of patients between the ages of 75 and 79, and 29% of patients age 80 or older.
  • In spite of the more frequent detection of polyps in older patients, the increase in life expectancy that resulted from colonoscopy was smaller for older patients than for younger patients. Among patients between the ages of 50 and 54, the average gain in life expectancy that resulted from screening colonoscopy was roughly 10 months. In contrast, among patients aged 80 or older, the average gain in life expectancy was roughly one-and-a-half months.

The researchers conclude, “Screening colonoscopy in very elderly patients should be performed only after careful consideration of the potential benefits, risks, and patient preferences.”

Reference:Lin OS, Kozarek RA, Schembre DB et al. Screening Colonoscopy in Very Elderly Patients: Prevelance of Neoplasia and Estimated Impact on Life Expectancy. JAMA. 2006;295:2357-2365.

Related News:
Duration of Treatment Affects Survival in Elderly with Colon Cancer (4/28/2006)

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