A new study finds that routine colorectal cancer (CRC) screening is effective for people older than 75, but only if they are in otherwise good health. The study appeared in JAMA Oncology.
“Until now, there really weren’t clear data to help us decide whether patients should be screened after age 75,” says co-investigator Andrew T. Chan. MD, MPH, a gastroenterologist and chief of the Clinical and Translational Epidemiology Unit at MGH via a press release about the study. “Current guidance was largely based on modeling and extrapolation of studies conducted in other age groups, and not on solid data to show whether screening was actually helpful in an older population.”
In this prospective cohort study, researchers assessed 56,374 participants who had reached the age of 75 during follow-up (36.8% men, 63.2% women). Data were obtained from the Nurses’ Health Study (NHS) and Health Professionals Follow-up Study (HPFS) from January 1, 1988, through January 31, 2016, for the HPFS and June 30, 2016, for the NHS. They evaluated the history of both sigmoidoscopy or colonoscopy screening among those up to 75 years of age and after 75 years of age, making assessments every two years.
The primary outcomes were defined as the incidence of CRC and CRC-related mortality confirmed by National Death Index, medical records, and pathology reports. The researchers analyzed data from May 8, 2019, to July 9, 2020.
According to the results, endoscopy screening after 75 years was correlated with reduced risk of CRC incidence (HR=0.61; 95% CI, 0.51-0.74) and CRC-related mortality (HR=0.60; 95% CI, 0.46-0.78), regardless of screening history. However, the investigators noted, screening endoscopy after 75 years of age was not associated with risk reduction in CRC death among participants with cardiovascular disease (HR=1.18; 95% CI, 0.59-2.35) or significant comorbidities (HR=1.17; 95% CI, 0.57-2.43).
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Dr. Chan concluded: “These are the first empirical data that really demonstrate that there is value in continuing screening past age 75 for many individuals. But the key take-home message is that screening should be tailored according to individual risk factors.”