Colorectal Cancer Screening Receipt Does Not Differ by 10-Year Mortality Risk Among Older Adults

Abstract

Background: Health status and life expectancy are important considerations for assessing potential benefits and harms of colorectal cancer (CRC) screening programs particularly among older adults. Methods: We examined receipt of past-year CRC screening according to predicted 10-year mortality risk among 25,888 community-dwelling adults aged 65-84 years who were not up to date with screening in the nationwide National Health Interview Survey. Ten-year mortality risk was estimated using a validated index; from the lowest to highest quintiles of the index, risk was 12%, 24%, 39%, 58%, and 79%, respectively. We also examined the proportion of screening performed among adults with life expectancy <10 years. Results: Prevalence of past-year CRC screening was 39.5%, 40.6%, 38.7%, 36.4%, and 35.4%, from the lowest to highest quintile of 10-year mortality risk. Odds of CRC screening did not differ between adults in the lowest vs. highest quintile (adjusted OR 1.05, 95% CI: 0.93-1.20). One-quarter (27.9%) of past-year CRC screening occurred in adults with life expectancy <10 years, and more than half (50.7%) of adults age 75-84 years had 10-year mortality risk ≥50% at the time of screening. In an exploratory analysis, invasive but not non-invasive screening increased as 10-year mortality risk increased (p<0.05) among adults 70-79 years. Conclusion: Past-year CRC screening does not differ by predicted 10-year mortality risk. An age-based approach to CRC screening results in under-screening of older, healthier adults and over-screening of younger adults with chronic conditions. Personalized screening with incorporation of individual life expectancy may increase the value of CRC screening programs.

Surveillance colonoscopy findings in asymptomatic participants over 75 years of age

“…Thus, it is important to identify individuals with higher risk of CRC who are ≥75 years, and those fit to undergo colonoscopy. 37 One concern in this older population is an increased risk of procedural complications, where age and increasing comorbid state are known to be associated with an increased risk of hospitalization and patient mortality. 4,16,29,30,32,38 Age ≥75 years and increasing CCI are both known risk factors for adverse colonoscopy outcomes.…”

“…We observed equal distribution of advanced‐stage (Stages III and IV) and earlier stage (Stages I and II) CRC which may be attributed to the finding of higher metachronous or recurrent cancers in the elderly people following a prior CRC diagnosis, necessitating frequent colonoscopy follow‐up. Thus, it is important to identify individuals with higher risk of CRC who are ≥75 years, and those fit to undergo colonoscopy 37 …”

“…Thus, it is important to identify individuals with higher risk of CRC who are ≥75 years, and those fit to undergo colonoscopy. 37 …”