Should we screen for colorectal cancer in people aged 75 and over? A systematic review - collaborative work of the French geriatric oncology society (SOFOG) and the French federation of digestive oncology (FFCD)

Guittet, Lydia; Quipourt, Valérie; Aparicio, Thomas; Carola, Élisabeth; Seitz, Jean‐François; Paillaud, Éléna; Lièvre, Astrid; Boulahssass, Rabia; Vitellius, Carole; Bengrine, Leila; Canouï‐Poitrine, Florence; Manfrédi, Sylvain

doi:10.1186/s12885-022-10418-5

Cited by 6 publications

(4 citation statements)

References 89 publications

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“…age or gender, potentially modified the risk or the consequences of physical harm. However, we found that arrhythmia, vasovagal events, heart failure, and acute coronary syndrome, occurred at higher rates among older people and if polypectomy is performed, which is consistent with findings in other studies [63] and in other reviews [64], potentially caused by the greater comorbidity in this age group, which have led to debate about the appropriate cut-off age for when to stop screening [65,66].…”

Section: Plos Onesupporting

confidence: 90%

Deaths and cardiopulmonary events following colorectal cancer screening—A systematic review with meta-analyses

Martiny,

Bie,

Jauernik

et al. 2024

PLoS ONE

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Background Colorectal cancer screening programmes (CRCSPs) are implemented worldwide despite recent evidence indicating more physical harm occurring during CRCSPs than previously thought. Therefore, we aimed to review the evidence on physical harms associated with endoscopic diagnostic procedures during CRCSPs and, when possible, to quantify the risk of the most serious types of physical harm during CRCSPs, i.e. deaths and cardiopulmonary events (CPEs). Methods Systematic review with descriptive statistics and random-effects meta-analyses of studies investigating physical harms following CRCSPs. We conducted a systematic search in the literature and assessed the risk of bias and the certainty of the evidence. Results We included 134 studies for review, reporting findings from 151 unique populations when accounting for multiple screening interventions per study. Physical harm can be categorized into 17 types of harm. The evidence was very heterogeneous with inadequate measurement and reporting of harms. The risk of bias was serious or critical in 95% of assessments of deaths and CPEs, and the certainty of the evidence was very low in all analyses. The risk of death was assessed for 57 populations with large variation across studies. Meta-analyses indicated that 3 to 23 deaths occur during CRCSPs per 100,000 people screened. Cardiopulmonary events were assessed for 55 populations. Despite our efforts to subcategorize CPEs into 17 distinct subtypes, 41% of CPE assessments were too poorly measured or reported to allow quantification. We found a tendency towards lower estimates of deaths and CPEs in studies with a critical risk of bias. Discussion Deaths and CPEs during CRCSPs are rare, yet they do occur during CRCSPs. We believe that our findings are conservative due to the heterogeneity and low quality of the evidence. A standardized system for the measurement and reporting of the harms of screening is warranted. Trial registration PROSPERO Registration number CRD42017058844.

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Section: Plos Onesupporting

confidence: 90%

Deaths and cardiopulmonary events following colorectal cancer screening—A systematic review with meta-analyses

Martiny,

Bie,

Jauernik

et al. 2024

PLoS ONE

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“…Given the life expectancy of the elderly, the risk of overdiagnosis is certainly greater. Most of the benefit-risk data for CRC screening over 75 years came from simulation studies ( 32 ). In our study, it found that age of 75 is the peak of CRC onset, which is correlated to the current status of CRC screening in the elderly.…”

Section: Discussionmentioning

confidence: 99%

Long-term trends in the burden of colorectal cancer in Europe over three decades: a joinpoint regression and age-period-cohort analysis

Long,

Mao,

Zhang

et al. 2023

Front. Oncol.

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BackgroundThe burden of colorectal cancer (CRC) in Europe is at a high level, but the epidemiological features have not yet been systematically studied. This study aimed to provide a timely and reliable assessment of the burden and trends of CRC in Europe to provide a scientific basis for its prevention and treatment.MethodsWe analyzed data on CRC in 44 European countries between 1990 and 2019 from the Global Burden of Disease study (GBD) 2019. In addition, the joinpoint regression model was applied to reflect temporal trends. The age-period-cohort model was constructed to explore age, period, and birth cohort effects that influence the risk of morbidity and mortality.ResultsIn Europe, new cases, disability-adjusted life years (DALYs) and deaths of CRC rose by 70.01%, 22.88% and 38.04% from 1990 to 2019, respectively. The age-standardized incidence rate (ASIR) has increased, while age-standardized DALY rate and age-standardized mortality rate (ASMR) have declined. We found that men experienced a significantly higher CRC burden than women. Age-period-cohort analysis showed that the risk of incidence and mortality increased with age and time; and it was lower in the later-born cohort than the earlier-born cohort.ConclusionASIR for CRC in Europe generally trended upwards from 1990 to 2019, stabilizing in recent years but still at a high level. CRC burden varied considerably in different countries. There was a pronounced gender difference in CRC burden, and middle-aged and older men should be a priority population for CRC prevention and treatment.

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“…Relying on chronological age alone can lead to both overscreening (e.g., colonoscopy in a 74-year-old man with multiple chronic conditions) and underscreening (e.g., no screening in a healthy 76-year-old woman without chronic conditions). These scenarios underscore the importance of incorporating life expectancy and chronic conditions when considering CRC screening (13–16).…”

Section: Introductionmentioning

confidence: 99%

“…Relying on chronological age alone can lead to both overscreening (e.g., colonoscopy in a 74-yearold man with multiple chronic conditions) and underscreening (e.g., no screening in a healthy 76-year-old woman without chronic conditions). These scenarios underscore the importance of incorporating life expectancy and chronic conditions when considering CRC screening (13)(14)(15)(16). We used the National Health Interview Survey (NHIS) (17) to 1) estimate the prevalence of and factors associated with CRC screening among older adults aged 65-84 years who were not upto-date on CRC screening according to predicted 10-year mortality risk and 2) examine the proportion of screening performed among adults with life expectancy ,10 years, defined as 10-year mortality risk $50%.…”

Section: Introductionmentioning

confidence: 99%

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

Liu,

Singal,

Murphy

2023

Am J Gastroenterol

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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.

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Should we screen for colorectal cancer in people aged 75 and over? A systematic review - collaborative work of the French geriatric oncology society (SOFOG) and the French federation of digestive oncology (FFCD)

Cited by 6 publications

References 89 publications

Deaths and cardiopulmonary events following colorectal cancer screening—A systematic review with meta-analyses

Deaths and cardiopulmonary events following colorectal cancer screening—A systematic review with meta-analyses

Long-term trends in the burden of colorectal cancer in Europe over three decades: a joinpoint regression and age-period-cohort analysis

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

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