At what age should colorectal cancer (CRC) screening be stopped in average-risk individuals?

Colorectal Cancer Screening Age Guidelines: When to Stop Screening

Colorectal cancer screening should be discontinued at age 75 for individuals who are up to date with screening and have negative prior screening tests, particularly colonoscopy, or when life expectancy is less than 10 years. 1

Age-Based Recommendations for Stopping CRC Screening

• For individuals aged 75 years who are up to date with screening and have negative prior screening tests, particularly high-quality colonoscopy, screening should be discontinued 1
• For persons aged 76-85 years without prior screening, screening may be considered depending on their health status and comorbidities 1
• For individuals aged 76-85 years, screening decisions should be individualized based on:
  • Overall health status 1
  • Prior screening history 1, 2
  • Life expectancy 1, 2
  • Patient preferences 1, 2
• Individuals aged 86 years and older should not be offered CRC screening under any circumstances 1

Evidence Supporting These Recommendations

• The U.S. Multi-Society Task Force on Colorectal Cancer (MSTF) provides a weak recommendation with low-quality evidence to stop screening at age 75 for those with negative prior screening 1
• The American Cancer Society (ACS) offers qualified recommendations to continue screening through age 75 for those in good health with life expectancy >10 years 1
• Multiple professional societies consistently recommend against screening after age 85, as the harms outweigh the benefits 1
• Recent studies show that among 76-85 year-olds with a recent negative stool-based test, the cumulative risk of death from other causes was over 100 times more likely than death from colorectal cancer 3

Risk-Benefit Analysis for Older Adults

• Benefits of screening decrease with age while potential harms increase 2
• Potential harms in older adults include:
  • Higher risk of procedural complications from colonoscopy 2
  • False-positive results leading to unnecessary follow-up procedures 2
  • Overdiagnosis of cancer that would not have caused symptoms in the patient's lifetime 2

Common Pitfalls to Avoid

• Continuing screening beyond age 85 when evidence clearly shows harms outweigh benefits 1, 2
• Stopping screening too early (before age 75) in healthy individuals with no prior screening history 1
• Not considering life expectancy when making screening decisions for adults aged 75-85 1, 2
• Failing to recognize that the risk of death from non-colorectal cancer causes significantly exceeds the risk of colorectal cancer mortality in adults over 75 3

Practical Algorithm for Deciding When to Stop Screening

1. For patients aged 75 years:

   • If up to date with screening and negative prior results: Stop screening 1
   • If never screened: Consider offering screening 1

2. For patients aged 76-85 years:

   • If life expectancy <10 years: Stop screening 1, 2
   • If significant comorbidities: Stop screening 2
   • If good health, no prior screening: Consider offering screening up to age 85 1

3. For patients aged 86 years and older:

   • Discontinue all colorectal cancer screening regardless of prior screening history 1