When to Stop Colonoscopy Screening
Individuals who are up to date with screening and have negative prior screening tests should consider stopping colonoscopy at age 75 years or when life expectancy is less than 10 years. 1
Primary Stopping Age Recommendation
For patients with prior negative screening (particularly colonoscopy), discontinue routine screening at age 75 years. 1, 2 This is a weak recommendation based on low-quality evidence, but represents the most current consensus from the U.S. Multi-Society Task Force on Colorectal Cancer. 1
The rationale is straightforward: colorectal cancer mortality rates begin to decrease within 5 years of initiating screening, but benefits become limited by competing causes of death as patients age. 1
Age-Based Stopping Algorithm
Ages 75 and Under
- Continue screening if up to date and in good health 1, 2
- Life expectancy >10 years strongly favors continued screening 1, 3
Ages 76-85
- Selective screening only 2, 4
- Consider screening ONLY if: 1
- No prior screening history AND
- Good functional status with minimal comorbidities AND
- Life expectancy >10 years
- The U.S. Preventive Services Task Force assigns this a Grade C recommendation (selective screening based on individual circumstances) 2
Age 85 and Older
- Do not screen 1, 2
- Screening is explicitly not recommended regardless of prior screening history 1, 2
- Harms outweigh benefits due to competing mortality risks 1
Critical Modifying Factors
Prior Screening History
Never-screened patients warrant consideration for screening up to age 85, depending on comorbidities. 1, 2 This represents a major exception to the age 75 stopping rule. 1
A 2021 simulation study demonstrated that unscreened women without comorbidities benefited from annual FIT screening until age 90, whereas unscreened men benefited until age 88. 1 However, this evidence is based on modeling rather than clinical trials.
Comorbidity Status
Severe comorbidities dramatically lower the appropriate stopping age. 1 Patients with severe comorbidities (AIDS, COPD, cirrhosis, chronic hepatitis, chronic renal failure, dementia, CHF, or combinations of moderate conditions like peripheral vascular disease with cerebrovascular disease) showed no benefit from screening beyond age 66. 1
Life Expectancy Calculation
Use a 10-year life expectancy threshold as the primary decision point. 1, 2, 3 Online calculators can provide objective estimates rather than relying on subjective clinical judgment. 3
Quality of Prior Colonoscopy
High-quality colonoscopy with negative findings provides the strongest rationale for stopping at age 75. 1 Quality indicators include: 4
- Cecal intubation with photo-documentation
- Adequate bowel preparation
- Adenoma detection rate ≥25%
- Withdrawal time ≥6 minutes
Common Pitfalls to Avoid
Do not continue routine screening in patients over 85 years regardless of health status. 1, 2 A 2022 registry study found that 27.4% of patients ≥85 years with no significant findings and 66.7% with advanced polyps were still told to continue colonoscopy—this represents overuse. 5
Do not make decisions based solely on age. 6 A 2015 cost-effectiveness analysis demonstrated that screening some previously screened, low-risk 66-year-olds was not cost-effective, while screening some healthy, high-risk 88-year-olds remained cost-effective. 6
Do not ignore the 10-15 year lag time to benefit from screening. 5 This lag time must be weighed against life expectancy, as the psychological distress and costs of screening may outweigh benefits in patients unlikely to live long enough to benefit. 5
Surveillance After Polypectomy
Different rules apply for surveillance colonoscopy after adenoma removal versus screening. 7 There is currently no clear guidance on when surveillance should stop in patients with prior adenomas, creating uncertainty among clinicians. 7
For patients with prior adenomas, the decision becomes more complex because cancer risk is elevated. 7 However, the same age and life expectancy considerations should apply—surveillance should generally stop at age 75-85 depending on comorbidities and prior findings. 1
Shared Decision-Making Elements
When discussing stopping screening with patients, address: 1, 3
- Prior screening history and findings
- Current age and functional status
- Comorbidity burden and life expectancy
- Patient preferences and perceived cancer risk
- Competing mortality risks
The decision to stop screening should involve explicit discussion of these factors rather than deferring automatically to age cutoffs or specialist recommendations. 7