I work in an outpatient clinic. Recently a patient who's nearly 80 asked me if he should schedule a screening colonoscopy to check for colon cancer. I advised him to discuss risks and benefits with his healthcare provider, but now I'm wondering: Are any guidelines available for older adults?-P.D., CALIF.
Your question is timely, because the U.S. Preventive Services Task Force (USPSTF) has just released new guidelines for colorectal cancer screening based on the patient age. The following recommendations apply to patients at average risk for colorectal cancer who have no signs or symptoms that might suggest colorectal cancer.
* Adults age 50 to 75 should undergo colorectal cancer screening with colonoscopy every 10 years, sigmoidoscopy every 5 years combined with a high-sensitivity fecal occult blood test (FOBT) every 3 years, or an annual high-sensitivity FOBT. The benefits of screening outweigh the potential harms in this age group.
* The USPSTF recommends against routine colorectal cancer screening in adults age 76 to 85, because the likelihood that detection and early intervention will yield a mortality benefit declines after age 75. However, the guidelines recognize that screening may be appropriate for some individuals in this age-group. Patients should discuss risks and benefits of the procedure with their healthcare provider.
* The USPSTF recommends against screening for colorectal cancer in adults over age 85 because the risks outweigh the benefits.
At this time, the task force doesn't recommend screening with computerized tomography colonography (virtual colonoscopy) or fecal DNA testing because of insufficient evidence to assess the benefits and harms. In addition, the USPSTF recommends against the use of aspirin or nonsteroidal anti-inflammatory drugs for the primary prevention of colorectal cancer.
You can find the complete guidelines in the November 4 issue of Annals of Internal Medicine.G