When Are You Too Old to Get a Colonoscopy?

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Results of a recent cross-sectional study suggest that surveillance colonoscopy may be riskier than it’s worth for adults aged 70 and older.

Can you be too old to get a colonoscopy?

Perhaps, according to results from a cross-sectional conducted at Kaiser Permanente Northern California in Oakland, California. The study was published on April 2 in JAMA Network Open.

The results indicated colonoscopies rarely detect colorectal cancer in older adults—even if they have a history of benign tumors called adenoma. Adenomas typically begin in the tissue covering organs and glands. These mushroom-shaped tumors can grow in the colon, and while they aren’t cancerous, health care professionals usually consider them to be precancerous.

Adenomas are found in 4o percent of screening colonoscopies in the United States. If they are discovered during colonoscopies, physicians usually recommend removing them. After removal, current guidelines recommend that patients undergo future surveillance colonoscopies. However, guidelines do not provide much direction as to how long a person should undergo this surveillance.

“Given the increasing aging population of in the US and that nearly 5.6 million adults older than 75 will undergo surveillance annually by 2024, estimating the yield of surveillance colonoscopy is important for understanding the balance between potential benefits and known risks of colonoscopy with advancing age,” researchers wrote.

Known risks of colonoscopies include bleeding, perforation of the colon, sedation-related effects, infection, heart attack, severe abdominal pain, and stroke. Bleeding, which occurs in 15 of every 10,000 procedures, and perforation are the most common complications. Most cases of bleeding and perforation occur in older individuals or those who have had adenomas or other polyps removed, according to the National Institute of Diabetes and Digestive and Kidney Diseases.

Less Than 1 Percent of Colonoscopies Found Cancer in Older Adults

In the cross-sectional study of 9,601 patients between the ages of 70 and 85 with a history of adenoma, only 0.3 percent of surveillance colonoscopies detected cancer. About 12 percent found advanced adenoma and advanced neoplasia (abnormal growth). Researchers noted that results did not differ significantly by age.

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Patients with a history of advanced adenoma were more likely to have colorectal cancer detected by surveillance than patients with non-advanced adenoma. Additionally, patients with advanced adenoma were also more likely to have advanced neoplasia, which is growth over 10 millimeters in diameter.

Other factors associated with advanced neoplasia were a body mass index (BMI) over 30 and a history of smoking tobacco. Individuals of Asian or Pacific Islander descent were less likely to have advanced neoplasia.

Findings Emphasize Importance of Individualized Care

The research team suggested their findings could inform older patients and clinicians when individualizing care, as surveillance colonoscopies may do more harm than good at a certain age.

“The low rate of [colorectal cancer] detection at surveillance may not justify the potential harms and burdens of colonoscopy that may increase with age,” they wrote.

However, they did note that colonoscopies could continue to save the lives of those with histories of adenomas.

“For some older adults with a predicted life expectancy of 10 or more years and without significant competing comorbidities, especially for those with a prior advanced adenoma, detection of early-stage [colorectal cancer] or advanced adenomas at surveillance could lead to earlier treatment and improved outcomes,” the team wrote.

The American Cancer Society estimates that just over 106,000 Americans will be diagnosed with colon cancer in 2024, and just over 46,000 will be diagnosed with rectal cancer. While its rates in older adults have dropped since the 1980s, colorectal cancer is still the third leading cause of cancer-related death in men and the fourth in women. When combined for both sexes, it’s the second most common cause of cancer death. It is expected to take the lives of just over 53,000 Americans in 2024.

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