Until what age should colorectal cancer screening be continued in Alberta?

Colorectal Cancer Screening Age Guidelines in Alberta

Colorectal cancer screening in Alberta should be discontinued at age 75 years for individuals with negative prior screening tests, particularly colonoscopy, or when life expectancy is less than 10 years. 1

Age to Stop Screening: Evidence-Based Recommendations

General Guidelines for Stopping Screening

• Individuals who are up to date with screening and have negative prior screening tests, particularly high-quality colonoscopy, should consider stopping screening at age 75 years or when life expectancy is less than 10 years 1
• For persons aged 76-85 years, the decision to continue screening should be individualized based on:
  • Prior screening history
  • Overall health status
  • Life expectancy
  • Patient preferences 1
• Individuals over age 85 years should be discouraged from continuing colorectal cancer screening 1

Specific Considerations for Different Patient Groups

• Persons without prior screening may benefit from screening up to age 85, depending on their age and comorbidities 1
• Recent modeling studies suggest that previously unscreened women with no comorbid conditions could benefit from initial screening through age 90, while unscreened men could benefit through age 88 2
• Individuals with severe comorbidities (such as AIDS, COPD, cirrhosis, chronic hepatitis, chronic renal failure, dementia, congestive heart failure) should stop screening at age 66 or younger, regardless of sex 1, 2

Screening Modality Considerations

• The Multi-Society Task Force recommends either colonoscopy every 10 years or annual fecal immunochemical test (FIT) as first-tier screening options 3
• When deciding whether to continue screening in older adults, the screening method should be considered:
  • Colonoscopy carries higher procedural risks in older adults
  • FIT testing may be more appropriate for older adults with comorbidities 1

Alberta-Specific Context

• Despite guidelines, uptake of colorectal cancer screening in Alberta has historically been low, with only 14.3% of average-risk adults aged 50-74 being up-to-date on screening according to earlier studies 4
• Alberta primary care physicians have expressed concerns about cost-effectiveness, inconsistencies between guidelines, and resource availability for implementing colorectal cancer screening programs 5

Balancing Benefits and Harms in Older Adults

• The benefits of continued screening decrease with age while potential harms increase 1, 2
• Potential harms include:
  • Procedural complications
  • False-positive results leading to unnecessary follow-up procedures
  • Overdiagnosis of cancer that would not have caused symptoms in the patient's lifetime 1
• The optimal age to stop screening should balance these considerations against the potential life-years gained 2

Common Pitfalls to Avoid

• Continuing screening beyond age 85 when evidence shows harms outweigh benefits 1
• Stopping screening too early in healthy individuals with no prior screening history 1
• Failing to consider comorbidities when determining the appropriate age to stop screening 2
• Not accounting for patient preferences in the decision-making process 1

By following these evidence-based guidelines, clinicians can make appropriate recommendations about when to discontinue colorectal cancer screening for their patients in Alberta, maximizing benefits while minimizing potential harms.