Risks May Outweigh Benefits in Surveillance Screening of Elderly with Colon Cancer History

In a recent study published in the Journal of the American Medical Association Internal Medicine, researchers reported that patients over 75 with a history of colon polyps or cancer undergoing surveillance colonoscopies are at an increased risk for post-procedure hospitalizations as compared to younger patients with similar histories.

The U.S. Prevention Services Task Force recommends that the general public begin regular colon cancer screening, including colonoscopies, at age 50. If by age 75 there are no negative findings, the American College of Physicians recommends stopping the colonoscopy screening.

Those found to have high-risk polyps or colon cancer itself are given colonoscopies every few years after treatment to ensure it does not recur. The study looked at these patients undergoing surveillance colonoscopies to assess the risks and benefits involved.

Researchers studied more than 5000 patients over 75 with a history of colorectal cancer or high-risk polyps and compared them to 23,000 patients 50 – 74 who also had had a previous occurrence with the disease or problematic polyps. Researchers looked at the number of cancer recurrences and the rate of adverse effects of screening, defined as hospitalizations within 30 days of the colonoscopies.

The study showed that of the total 373 colon cancers found over a nine-year period, only five were among the older group. However, this group experienced 527 hospitalizations, whereas the younger group had only 184 hospitalizations. Researchers also determined that the rate of hospitalizations increased with age.

Thirteen percent of the post colonoscopy problems included gastrointestinal (GI) bleeding, GI perforation or arrhythmia. Thirty-three percent of hospitalizations were for GI problems unrelated to the procedure. Non-GI problems accounted for the remaining hospitalizations.

Researchers concluded that recurrences of colon cancer after age 75 are rare and that the risks of repeated colonoscopies may outweigh the benefits.

Reference:Tron, A.H. et al. Surveillance Colonoscopy in Elderly Patients – A Retrospective Cohort Study. JAMA Intern Med. Published online August 11, 2014. doi:10.1001/jamainternmed.2014.3746.

Tags: Colon Cancer, colon cancer cancer screening, colonoscopy, News Tips and Features, News Tips and Features Other, Screening/Prevention Colon Cancer