Many older people think they should still be screened for colon cancer after age 75.
At least that’s the conclusion of a study published on December 3 in the journal JAMA Network Openwhich found that 40% of adults over the age of 50 found the 75-year cut-off for routine colon cancer screenings to be “somewhat” or “very” unacceptable.
Although the study focused specifically on colon cancer, the guidelines for that type fall under the umbrella of “colorectal cancer,” which is cancer that starts in the colon or rectum. They suggest routine screenings like a colonoscopy for an average-risk person starting at age 45 or 50 to increase the chances of getting it earlier, when it’s often most treatable.
But age 75 marks a turning point when the risks of testing outweigh the benefits, experts say.
That’s why the US Preventive Services Task Force and other groups are calling for individualized screenings starting at age 75 and for people to stop getting screened altogether at age 85. The American College of Physicians takes a stronger stance, recommending that routine screening end at age 75 for adults at average risk without symptoms of colorectal cancer and with a life expectancy of no more than 10 years.
But according to a new study, many older adults disagree with the 75-year age limit for routine screening for colon cancer, which accounts for the second-highest number of cancer-related deaths in the U.S. when combined with rectal cancer deaths.
“More than anything else, this research shows that many older adults are deeply skeptical of messages asking them to stop getting colon screening tests like colonoscopies,” he said. Brian J. Zikmund-Fisher, PhDstudy co-author and professor in the Department of Health Behavior and Health Equity at the University of Michigan School of Public Health.
“However, for some older adults, more colonoscopies are more likely to harm the person than to help them,” he said. Health. “Somehow, we have to figure out how to have that conversation openly and honestly with older people.”
Researchers analyzed responses from 1,302 people who participated in the 2018 wave of the Health and Retirement Study, an ongoing study of about 20,000 American adults age 50 and older conducted by the University of Michigan.
The study sample included 794 women and 508 men, and 23% had limited life expectancy based on the Lee index, a risk calculator used to predict mortality.
Participants were asked whether guidelines to stop screening for colon cancer in those over 75 because of harms that may outweigh the benefits of finding a new cancer were “very unacceptable”, “somewhat unacceptable”, “somewhat acceptable” or “very acceptable” .
After their analysis, the researchers found that 60% rated the guidelines as very or somewhat acceptable. In comparison, nearly 40% said the guidelines were somewhat or very unacceptable.
Notably, estimated life expectancy did not affect responses — 39.2% of those with a limited life expectancy and 39.7% with a longer life expectancy found the guidelines unacceptable.
Laura Brotzman, MPHstudy co-author and doctoral candidate in the Department of Health Behavior and Health Equity at the University of Michigan, said that in interviews, some older adults revealed that they believed age restrictions on screening were cost-saving measures that limited individual choice and personalized care.
“Many of the older adults in these interviews believed that life expectancy was either irrelevant or too incomplete to guide cancer screening decisions,” Brotzman said. Health. “They also tend to believe that the potential benefits of cancer screening outweigh the potential harms or risks, and express concern about their life expectancy being estimated and used to deny them screening.”
Screening restrictions boil down to the risks of screening outweighing the benefits, experts say.
Although colonoscopies are routine, they still pose a potential danger. The procedure can cause bleeding and intestinal tears, and those risks increase after age 75 and continue to increase after age 85. Theodore R. Levin, MD, gastroenterologist, colorectal cancer screening clinical leader and research scientist at the Kaiser Permanente Division of Research in Northern California, said Health.
People over 75 also have a reduced life expectancy and are more likely to die from something other than colorectal cancer, such as cardiovascular disease or other cancers, Philip A. Philip, MDsaid director of gastrointestinal oncology at the Henry Ford Cancer Institute Health.
One study found that death from other causes was over 100 times greater than death from colorectal cancer among 76- to 85-year-olds with a recent negative stool-based colorectal cancer screening test.
“The key argument is the fact that over the age of 75 the chances of someone having a disease or co-morbidity that will lead to death is quite high,” said Philip, “and therefore thinking of only colorectal cancer as a cause of death is not realistic in preventing death in general in those older of 75 years.”
The reasoning behind recommended screening ages for other cancers, such as cervical or breast, is similar, but the specific guidelines differ, Zikmund-Fisher pointed out. “The trade-off between the benefits of further screening tests and the risks of doing so is different in each case,” he said.
Just because you’re over 75 doesn’t mean you can never get screened for colon cancer. The first step is to talk to your doctor about whether screening makes sense for you. “It’s important for patients to have honest conversations with their doctor about their overall health, lifestyle care plans and how likely they are to benefit from colorectal cancer screening,” Levin said.
When considering whether screening would benefit you, experts say your doctor will likely consider your current health and life expectancy. “Life expectancy is increasingly recognized as a more nuanced metric than age alone that guides cancer screening decisions for older adults,” Brotzman said.
Previous screening history is another key factor to consider, Levin said. While studies show that those over 75 who are screened are more likely to die from something other than colorectal cancer, “the calculus is much different for people who are not screened regularly,” Levin said. “There may be a much greater benefit to screening after 75 if people are not up to date with colonoscopy or faecal screening tests.”