At what age should colonoscopy be stopped?

Age to Stop Colonoscopy Screening

For individuals up to date with screening who have had negative prior screening tests (particularly colonoscopy), consider stopping at age 75 years or when life expectancy is less than 10 years. 1

Algorithmic Approach Based on Age and Screening History

Ages 75 and Under

• Continue routine screening if the patient has not completed age-appropriate screening, regardless of prior screening history. 1

Ages 76-85

The decision depends critically on prior screening history:

Previously Screened Patients (Up to Date)

• Stop screening at age 75 if they have had negative prior screening tests, particularly a negative colonoscopy. 1, 2, 3
• Alternative threshold: Stop when life expectancy falls below 10 years, regardless of exact age. 1

Never-Screened or Under-Screened Patients

• Consider screening up to age 85, but only after careful assessment of comorbidities, overall health status, and life expectancy. 1, 2, 3
• These individuals may derive substantial benefit since they lack the protective effect of prior negative screening. 1
• Screening can be cost-effective in healthy 81-year-old individuals with no prior screening and average CRC risk. 4

Age 86 and Older

• Do not offer screening. The overall mortality risk and adverse events from colonoscopy outweigh any potential life expectancy benefits at this age. 1, 2, 3

Key Factors That Modify These Age Cutoffs

Comorbidity Status

• Severe comorbidities: Stop screening at age 66 regardless of prior screening history. 2
• The presence of conditions that substantially limit life expectancy should prompt earlier cessation. 1

CRC Risk Level

• Higher background CRC risk (e.g., family history, prior advanced adenomas): May justify screening at older ages than average-risk individuals. 4
• Lower background CRC risk with prior negative colonoscopy: May warrant stopping even before age 75. 4

Prior Screening Findings

• Patients with previously detected advanced neoplasia may benefit from continued surveillance colonoscopy even at advanced age, depending on comorbidities and confidence that neoplasia was completely cleared. 1

Evidence Quality and Nuances

The recommendations to stop screening at age 75 for previously screened individuals carry weak recommendation strength with low-quality evidence. 1 However, this represents the best available guidance from multiple major guideline organizations including the U.S. Multi-Society Task Force on Colorectal Cancer. 1

The recommendation to consider screening never-screened individuals up to age 85 similarly carries weak recommendation strength with low-quality evidence. 1 Modeling studies demonstrate that screening remains cost-effective in some healthy, high-risk individuals until age 88. 4

Critical Pitfalls to Avoid

• Continuing screening beyond age 85: Evidence consistently shows harms outweigh benefits at this age. 1, 2, 3
• Stopping screening prematurely in never-screened healthy individuals: A healthy 80-year-old with no prior screening may derive substantial benefit, whereas a 74-year-old with multiple negative colonoscopies and comorbidities may not. 4
• Age-only decision making: Current practice often relies primarily on age, resulting in underuse in some patients and overuse in others. 4
• Recommending continued colonoscopy despite advanced age and insignificant findings: Registry data show that 27.4% of patients ≥85 years with no significant findings are still told to continue colonoscopy, which is inappropriate. 5

Practical Implementation

Real-world data reveal that colorectal cancer detection during colonoscopy in older adults is rare (0.71% overall), with advanced polyps found in only 7-14% depending on age and indication. 5 These low yields must be weighed against the known harms of colonoscopy, including procedural risks, cost, psychological distress, and the long lag time to benefit that may exceed remaining life expectancy. 5