At what age are screening colonoscopies (colon cancer screening tests) typically stopped for average-risk individuals?

When to Stop Colorectal Cancer Screening in Average-Risk Individuals

Screening colonoscopies should be discontinued at age 75 for average-risk individuals who are up-to-date with screening and have had negative prior screening tests, particularly high-quality colonoscopy. 1, 2

Age-Based Recommendations for Stopping Screening

• For individuals aged 75 years with negative prior screening tests and who are up-to-date with screening, colorectal cancer screening should be discontinued, particularly when life expectancy is less than 10 years 1, 2
• For persons aged 76-85 years, screening decisions should be individualized based on:
  • Overall health status 2
  • Prior screening history 1
  • Life expectancy 2
  • Patient preferences 1
• Individuals ages 86 and older should not be offered colorectal cancer screening as overall mortality risk and adverse events associated with colonoscopy outweigh the potential benefits 1, 2

Evidence Supporting These Recommendations

• The U.S. Multi-Society Task Force on Colorectal Cancer (MSTF) explicitly states that individuals ages 86 and older should not be offered CRC screening 1
• The American Cancer Society (ACS) suggests discontinuing screening at age 75 for those with negative prior screening tests 1
• The U.S. Preventive Services Task Force (USPSTF) provides a Grade C recommendation for selective screening in adults aged 76-85 years, indicating small net benefit 1
• Multiple professional societies agree that the decision to continue screening beyond age 75 should be individualized 1

Risk-Benefit Analysis for Older Adults

• Benefits of screening decrease with age while potential harms increase 2
• A 2023 study found that most screening colonoscopies performed in patients older than 75 years were in patients with limited life expectancy and were associated with increased risk of complications 3
• Adverse events requiring hospitalizations were common at 10 days post-colonoscopy (13.58 per 1000) and increased with age, particularly among patients older than 85 years 3
• Colorectal cancer was extremely rare (0.2%) in screened individuals over 75 years 3

Special Considerations

• Persons without prior screening may benefit from screening up to age 85, depending on their age and comorbidities 2, 4
• Individuals with severe comorbidities should stop screening earlier, at age 66 or younger 2
• The additional life-years gained from continuing screening after age 75 are generally small 5

Common Pitfalls to Avoid

• Continuing screening beyond age 85 when evidence clearly shows harms outweigh benefits 2
• Stopping screening too early in healthy individuals with no prior screening history 2
• Not considering the increased risk of complications in very elderly patients, including poor bowel preparation and incomplete colonoscopies 6
• Failing to engage in shared decision-making with patients aged 76-85 regarding the potential benefits and harms of continued screening 1

Algorithm for Decision-Making About Stopping Screening

1. For patients ≥75 years:

   • If up-to-date with negative prior screenings (especially colonoscopy) → Stop screening 1, 2
   • If never screened → Consider screening up to age 85 based on health status 2, 4

2. For patients 76-85 years:

   • Assess life expectancy (>10 years or <10 years) 1
   • Evaluate comorbidities and overall health status 2
   • Consider prior screening history 1
   • If healthy with >10 years life expectancy and no/inadequate prior screening → Consider screening 1
   • If limited life expectancy (<10 years) or significant comorbidities → Do not screen 2

3. For patients >85 years:

   • Do not offer colorectal cancer screening regardless of prior screening history 1, 2