What Age Should A Male Get A Colonoscopy – Does your 80-year-old patient really need that colonoscopy? – Doctors often ignore life expectancy when making screening decisions, research shows

A large proportion of screening colonoscopies in adults over age 75 were performed on individuals with limited life expectancy, a group that receives little benefit and is at greater risk of complications, according to findings from a major health care system.

What Age Should A Male Get A Colonoscopy

What Age Should A Male Get A Colonoscopy

In the cross-sectional study with a nested cohort of more than 7,000 patients who underwent colonoscopy for screening, 30% of those aged 76-80 years had a life expectancy of less than 10 years, a percentage that increased to 71% for the age groups of 81 years. -85 years, and up to 100% for the smaller group of patients aged 86 and older, Michael Rothberg, MD, MPH, of the Center for Value-Based Care Research at the Cleveland Clinic in Ohio, and colleagues reported.

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Of the entire study population, 37.7% had non-advanced neoplasia and 5.7% had advanced neoplasia, including 0.2% with colorectal cancer (CRC). The detection of advanced neoplasia increased with each age group (from 5.4% to 6.2% to 9.5%, respectively;

But since the benefits of CRC screening can last at least 10 to 15 years (the interval during which an adenoma develops into CRC), screening people with a limited life expectancy is of little benefit and must be weighed against the potential harms, according to the authors of the study. explained.

In the current study, patients with a life expectancy of less than 10 years were very unlikely to have their cancer treated, Rothberg and co-authors wrote in their discussion. “Additionally, older patients had a significantly increased rate of endoscopic adverse events, including serious gastrointestinal adverse events, hospitalizations, and perforations.”

Adverse events (AEs) leading to hospitalization within 10 days of the procedure were common, at 13.58 per 1,000 patients, and this rate increased with age. Overall, patients with limited life expectancy had double the rate of complications.

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The U.S. Preventive Services Task Force recommends against CRC screening for people over age 85, and recommends individualized decision-making for people ages 76-85, but the Task Force “does not determine how this practice might be implemented,” the researchers noted on.

Although using estimated life expectancy to determine who will benefit is a “better measure” than chronological age alone, the current study showed that doctors “often ignored” life expectancy and offered colonoscopy to people expected to live less than would live 10 years longer, Rothberg added. co-authors.

As guidelines have shifted to screening for CRC earlier in life, they suggested that reducing overscreening in older adults with limited life expectancy could reduce pressure on the healthcare system.

What Age Should A Male Get A Colonoscopy

“Of course, stopping screening in older adults can be challenging,” the researchers acknowledged. “Physicians should first calculate life expectancy (at least for people younger than 85 years), but may not have the tools to do so. Cho et al.’s tool offers one possible approach. Future studies should test the effects of the available establish such tools in the future. electronic medical records.”

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After exclusions, Rothberg and colleagues’ study included 7,067 patients older than 75 years who underwent outpatient screening colonoscopy at multiple Cleveland Clinic locations in Ohio and Florida from January 2009 to January 2022, with 82% of the cohort between 76 and 80 years of age was old. 14% are 81-85 years old and 4% are 86 years or older. A random review of 150 of these colonoscopies (50 for each age group) confirmed that 96% were indeed for screening colonoscopy.

People were excluded if they had incomplete data, had an indication for a colonoscopy other than screening, had a previous colonoscopy within the past five years, or had a history of colorectal cancer or inflammatory bowel disease.

Ultimately, the patients had an average of two comorbidities, were on average 78 years old, 56% were women and more than three-quarters were white.

The primary outcome of the study was the percentage of colonoscopies performed in patients with a life expectancy of less than 10 years, with estimates determined via the tool by Cho et al based on their comorbidities. Other outcomes included colonoscopy findings and side effects of the procedure.

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Measured by gender, 39% of men and 23% of women in the age group 76-80 years underwent a screening colonoscopy despite a life expectancy of less than 10 years. For the age groups 81-85 years, these percentages were 82% and 61% respectively. Only 3% of colonoscopies were performed in people with a life expectancy of less than 5 years.

Of the 15 patients in whom CRC was discovered, 10 received no anticancer treatment (patient or physician preference). One in nine patients with a life expectancy of less than ten years underwent treatment, compared to four in six patients with a life expectancy of at least ten years.

Serious side effects became more common as patients got older: 2.42 per 1,000 patients aged 76-80 years; 3.92 per 1,000 people aged 81 to 85; and 11.07 per 1,000 people aged 86 and over.

What Age Should A Male Get A Colonoscopy

Similarly, perforations occurred in the three groups at rates of 0.52, 1.95, and 3.69 per 1,000 people, respectively, with a rate observed in the oldest group “exceeding quality measures” of the American Society for Gastrointestinal Endoscopy/ American College. of the Gastroenterology Task Force on Quality in Endoscopy, the authors said.

Does Your 80 Year Old Patient Really Need That Colonoscopy?

Limitations cited by the researchers included the single-center design, the fact that the study included only patients who actually underwent screening, and that the specialty of the physicians ordering the colonoscopy was not identified. Assuming that some patients received care outside the health care system after the procedure meant that side effects were likely undercounted, they noted.

Rothberg had no revelations. A co-author reported relationships with Ambry Genetics, Janssen Pharmaceuticals, Emtora Biosciences, Freenome, Guardant Health, SLA Pharma and involvement with the National Comprehensive Cancer Network guidelines on risk assessment for colorectal cancer.

Source reference: El Halabi J, et al. “Frequency of use and outcomes of colonoscopy in persons over 75 years of age” JAMA Intern Med 2023; DOI: 10.1001/jamainintermed.2023.0435. The American Cancer Society (ACS) lowered the recommended age to start screening from 50 to 45 in 2018, citing a “marked increase” in the incidence of colorectal cancer among younger and middle-age groups.

Medical experts agree that colon cancer screening saves lives. When cancer is caught early, it can be easier to treat. There are several ways to screen for colon cancer, with a colonoscopy being considered the gold standard. It is helpful to discuss the best screening method with your doctor.

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During a colonoscopy, the doctor uses a thin, flexible tube to check for polyps or cancer in the rectum and colon. The doctor can find and remove most polyps and biopsy areas suspicious for cancer during the procedure. Colonoscopies are also used as a follow-up to other screening tests, including some stool tests and a flexible sigmoidoscopy.

If you choose to have a colorectal cancer screening test other than a colonoscopy, and the test result is abnormal, it should be followed by a colonoscopy for further evaluation.

Those at average risk for colorectal cancer should begin regular screening at age 45. ACS experts have found that earlier screening can help save more lives. Healthy people without risk factors should consult their doctor and plan to have a screening colonoscopy every 10 years through age 75.

What Age Should A Male Get A Colonoscopy

People between the ages of 76 and 85 should talk to their doctor about whether or not to continue screening. The decision should be based on personal preferences, life expectancy, overall health, and previous screening results.

Beyond Colonoscopy: What To Know About Alternative Colon Cancer Screenings

It is not uncommon for doctors to recommend colorectal cancer screening for someone under age 45, especially if that person has a family history of colorectal cancer.

Early and more frequent screening for a person in their 20s or 30s is not ruled out for those at higher risk. You may fall into this category if you:

No matter how old you are, contact your doctor if you have any symptoms that worry you. You can discuss together when you should start screening and how often you should be tested.

Blue Cross Blue Shield of Michigan and Blue Care Network will cover colorectal screenings for most members age 45 and older to align with the U.S. recommendation. Preventive Services Task Force. For more information click here.

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MI Blues Perspectives is sponsored by Blue Cross Blue Shield of Michigan, a nonprofit, independent licensee of the Blue Cross Blue Shield Association. Early 15 percent of colorectal cancers are diagnosed in people under age 50, suggesting it may be helpful to start regular screenings — including perhaps the dreaded colonoscopy — earlier than usual, according to a study published Monday in the magazine Cancer has been published.

The American Cancer Society calls for regular screening for colon cancer (which may include analysis of stool samples or barium enemas in addition to colonoscopy) to begin at age 50 in most cases, except for people whose close relatives have been diagnosed with colon cancer.

But Dr. Samantha Hendren, co-author of the paper, said these guidelines could cause doctors to miss a significant number of sick patients.

What Age Should A Male Get A Colonoscopy

“I’ve had patients under 50 come to me and say, ‘I’ve had symptoms for a year,’ and their doctors told them it was nothing to worry about,” says Hendren, a cancer researcher at the University of Michigan. “My hope is that this article will stimulate epidemiological research on costs versus benefits

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