From the Guidelines
For a 78-year-old female, routine screening colonoscopy is generally not recommended, as the decision to continue colorectal cancer screening in individuals older than 75 years should be individualized, based on an assessment of risks, benefits, screening history, and comorbidities 1. When considering colonoscopy for this patient, several factors must be taken into account, including:
- The patient's overall health status and life expectancy
- Their screening history and prior results
- The presence of any comorbidities that may increase the risk of complications from the procedure
- Any symptoms or risk factors that may indicate a higher likelihood of colorectal cancer, such as family history, rectal bleeding, or changes in bowel habits The most recent guidelines from the American Gastroenterological Association suggest that the decision to continue screening should be based on a risk-benefit assessment, taking into account the patient's individual characteristics and medical history 1. It's also important to consider alternative screening options, such as CT colonography or colon capsule endoscopy, which may be less invasive and have a lower risk of complications, although the evidence on their effectiveness in preventing colorectal cancer is limited 1. In general, the U.S. Preventive Services Task Force recommends against routine screening for colorectal cancer in adults over 75 years old who have had adequate prior screening and are not at increased risk, but notes that the decision to screen should be individualized based on the patient's health status, life expectancy, and preferences 1.
From the Research
Colonoscopy Recommendations for a 78-Year-Old Female
- The decision to undergo colonoscopy screening should be based on a case-by-case individualized discussion, considering factors such as the patient's morbidity and mortality risk from CRC, underlying comorbidities, functional status, and preferences for screening 2.
- For patients with a life expectancy of 10 years or more, screening and ongoing surveillance should be considered 2.
- A study found that most screening colonoscopies performed in patients older than 75 years were in patients with limited life expectancy and associated with increased risk of complications 3.
- The benefits of colorectal cancer screening may take 10 to 15 years to accrue, and screening is recommended for older adults who are in good health 3.
- Colonoscopy is considered safe, but the risks of complications of the bowel preparation, the procedure, and sedation medications are all increased in older patients 2.
- Noninvasive testing, such as fecal occult blood tests, provides a safe initial test, but has increased false-positive rates in the elderly, and a positive test result will usually necessitate colonoscopy to establish the diagnosis 2, 4, 5.
- A study found that colonoscopy in patients 80 years of age and older is safe, with a high success rate and diagnostic yield 6.
- The diagnostic yield of colonoscopy is high in older adults, with a significant proportion of patients diagnosed with colorectal cancer or adenomatous polyps 5, 6.