From the Guidelines
Colonoscopy at age 78 is not routinely recommended for most adults, but the decision should be individualized based on an assessment of risks, benefits, screening history, and comorbidities. The most recent and highest quality study, published in 2023 in the journal Gastroenterology 1, suggests that the decision to continue colorectal cancer (CRC) screening in individuals older than 75 years should be based on a risk-benefit assessment, taking into account factors such as screening history, comorbidities, and life expectancy.
When considering a colonoscopy at age 78, it's essential to weigh the potential benefits against the risks, which include bleeding, perforation, and complications from sedation, as noted in the 2023 study 1. The study also highlights that less intensive screening history, less severe comorbidities, and a greater number of risk factors for CRC are associated with cost-effective screening.
Key factors to consider include:
- Screening history: If you have a history of normal screening results, the benefits of continuing screening may be lower.
- Comorbidities: The presence of multiple comorbidities, such as cardiovascular disease, may reduce the benefits of screening.
- Life expectancy: If your life expectancy is limited, the benefits of screening may be reduced.
- Risk factors: If you have risk factors for CRC, such as a family history or personal history of polyps, the benefits of screening may be increased.
The 2021 US Preventive Services Task Force recommendation statement, published in JAMA 1, also supports individualized decision-making for CRC screening in adults aged 76 to 85 years.
In summary, while routine colonoscopy at age 78 is not recommended, the decision should be personalized based on individual factors, and less invasive options like fecal immunochemical testing may be considered, as suggested by the 2023 study 1.
From the Research
Colorectal Cancer Screening at 78 Years Old
- The decision to have a colonoscopy at 78 years old depends on various factors, including overall health, medical history, and risk factors for colorectal cancer.
- According to a systematic review and network meta-analysis published in 2019 2, sigmoidoscopy screening slightly reduces colorectal cancer incidence and mortality in individuals aged 50-79 years.
- Another study published in 1993 3 found that screening for colorectal cancer with fecal occult blood testing and sigmoidoscopy can increase the likelihood of early detection and treatment of the disease.
- Stool-based tests, such as fecal immunochemical testing (FIT) and multi-target stool DNA (MT-sDNA), are also effective in detecting colorectal cancer and may be preferred by some individuals due to their non-invasive nature 4, 5.
- A systematic review and critical appraisal of cost-effectiveness models published in 2023 6 found that sigmoidoscopy is a cost-effective screening strategy for colorectal cancer, particularly when combined with annual stool testing.
Screening Options and Recommendations
- The American Cancer Society recommends that adults aged 45-75 years undergo regular colorectal cancer screening with either a stool-based test or a visual exam (such as colonoscopy or sigmoidoscopy) 2, 5.
- The choice of screening test depends on individual preferences, medical history, and risk factors for colorectal cancer.
- It is essential to discuss the benefits and risks of each screening option with a healthcare provider to determine the best approach for individual circumstances.
Importance of Screening
- Colorectal cancer screening is crucial for reducing the incidence and mortality of the disease 2, 3, 4, 5, 6.
- Regular screening can detect precancerous polyps and early-stage cancers, allowing for prompt treatment and improved outcomes.
- Individuals aged 78 years and older should discuss their screening options with a healthcare provider to determine the best approach for their individual needs and health status.