When to Stop Colon Cancer Screening
For individuals who are up to date with screening and have had negative prior screening tests (particularly colonoscopy), consider stopping screening at age 75 years or when life expectancy falls below 10 years. 1
Age-Based Stopping Algorithm
Age 75 and Below
- Continue routine screening if the patient has not completed age-appropriate screening, regardless of prior screening history 2
- Patients with previously negative screening tests, especially high-quality colonoscopy, should consider stopping at age 75 1
- An alternative threshold is to stop when life expectancy falls below 10 years, regardless of exact age 1
Ages 76-85
- For never-screened or under-screened individuals, screening decisions should be individualized based on overall health status, comorbidities, life expectancy, and patient preferences 1
- These individuals may derive substantial benefit since they lack the protective effect of prior negative screening 1
- Previously unscreened women with no comorbidities could undergo initial screening through age 90, while unscreened men could screen through age 88 3
- The net benefit of screening all persons in this age group is small 1
Age 86 and Older
- Screening should not be offered to individuals age 86 and older, as the risks outweigh the benefits 4
- Clinicians should discourage individuals over age 85 from continuing CRC screening 1
Comorbidity-Modified Stop Ages
The presence of significant comorbidities substantially lowers the optimal stopping age:
- Patients with severe comorbidities should stop screening at age 66 years or younger, regardless of prior screening history 2, 3
- Screening should only be offered to patients healthy enough to undergo treatment if colorectal cancer is detected 1
- Conditions that substantially limit life expectancy should prompt earlier cessation of screening 2
Important Caveats
Surveillance vs. Screening
- These age recommendations apply to average-risk screening, not surveillance 1
- 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, 2
Evidence Quality
The recommendations to stop screening at age 75 for previously screened individuals carry weak recommendation strength with low-quality evidence 1. The recommendation to consider screening never-screened individuals up to age 85 similarly carries weak recommendation strength with low-quality evidence 1.
Common Pitfalls to Avoid
- Continuing screening beyond age 85 when evidence consistently shows harms outweigh benefits 4, 2
- Stopping screening too early in healthy individuals with no prior screening history 2
- Not considering that patients with a perfect screening history and severe comorbidities should stop much earlier (age 66) than healthy never-screened individuals 3