When to Stop Colon Cancer Screening
Stop routine colorectal cancer screening at age 75 in patients who are up-to-date with prior negative screening tests, particularly if they have had high-quality colonoscopy or life expectancy is less than 10 years. 1, 2, 3
Age-Based Stopping Framework
Age 75 and Under with Good Health
- Continue screening through age 75 if the patient has good health and life expectancy exceeds 10 years 1, 4
- The average time to prevent 1 CRC death is 10.3 years from screening, making screening futile when life expectancy falls below this threshold 1
- For 75-year-old men and women in the United States, average life expectancy is only 9.9 and 12 years respectively, meaning most will not benefit from continued screening 1
Ages 76-85: Selective Screening Only
- Offer screening only to patients who have never been screened previously, considering their overall health status, comorbidities, and whether they are healthy enough to undergo treatment if cancer is detected 1, 2
- For patients already up-to-date with screening, discontinue screening at age 76 as incremental benefits are minimal and harms increasingly outweigh benefits 1, 3
- The decision requires assessment of functional status, not just chronological age 3, 5
Age 86 and Older
- Do not offer CRC screening to individuals age 86 and older - overall mortality risk and procedural complications outweigh any potential life expectancy benefits 1
- Discourage all individuals over age 85 from continuing screening regardless of prior screening history 1, 2
Impact of Smoking History and Comorbidities
Your patient's significant smoking history is critical to this decision:
- Smoking increases competing mortality risks, effectively reducing life expectancy below the 10-year threshold needed for screening benefit 1
- Individuals with serious comorbid conditions (which smoking often causes, including COPD, cardiovascular disease, chronic renal failure) should stop screening even before age 75 1
- Among 70-year-old men and women with serious comorbidities, life expectancy is only 8.9 and 10.8 years respectively - below the screening benefit threshold 1
- Patients with severe comorbidities should stop screening at age 66 or younger, regardless of sex 3
Procedural Risk Considerations in Older Adults
The risks of colonoscopy specifically increase with age:
- Bowel preparation complications, procedural complications, and sedation-related adverse events all increase in older patients 5
- Colonoscopy carries higher procedural risks in older adults compared to younger populations 3
- These increased harms must be weighed against diminishing benefits as patients age 3, 5
Common Pitfalls to Avoid
- Do not continue screening past age 75 in patients with adequate prior negative screening history - this is the most common error, as harms increasingly outweigh benefits with advancing age 2, 3
- Do not ignore life expectancy calculations - use online calculators to estimate remaining life expectancy based on age and comorbidities rather than relying on chronological age alone 5
- Do not screen patients with less than 10 years life expectancy due to comorbidities like those caused by heavy smoking, as they will undergo unnecessary, burdensome, potentially harmful, and costly tests without benefit 1, 4
- Stopping screening too early in healthy individuals with no prior screening history is also inappropriate - these patients may benefit from screening up to age 85 depending on health status 2, 3