Abstract
Screening for colorectal cancer (CRC) in the elderly involves complex decision-making at the interface of gastroenterology, general internal medicine, geriatric medicine, public health, and medical ethics, and represents a unique and controversial issue in the modern health care landscape. Unlike starting and continuing screening, considerable uncertainty remains regarding the upper age limit, or appropriate set of circumstances, which would allow elderly patients to forgo CRC screening. This chapter will review issues pertaining to screening for CRC in elderly patients, including benefits and harms of screening, impact of screening on patient survival, and decision-making by patients and health care providers.
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References
Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ. Cancer statistics, 2009. CA Cancer J Clin. 2009;59(4):225–49.
Rex DK, Lehman GA, Ulbright TM, et al. Colonic neoplasia in asymptomatic persons with negative fecal occult blood tests: influence of age, gender, and family history. Am J Gastroenterol. 1993;88(6):825–31.
Ries LAG, Eisner M, Kosary CL, et al. SEER cancer statistics review, 1973-1999. Bethesda, MD: National Cancer Institute. Available at: http://seer.cancer.gov/csr/1973_1999/.
Imperiale TF, Wagner DR, Lin CY, Larkin GN, Rogge JD, Ransohoff DF. Results of screening colonoscopy among persons 40 to 49 years of age. N Engl J Med. 2002;346(23):1781–5.
Mandel JS, Bond JH, Church TR, et al. Reducing mortality from colorectal cancer by screening for fecal occult blood. Minnesota Colon Cancer Control Study. N Engl J Med. 1993;328(19):1365–71.
Kronborg O, Fenger C, Olsen J, Jorgensen OD, Sondergaard O. Randomised study of screening for colorectal cancer with faecal-occult-blood test. Lancet. 1996;348(9040):1467–71.
Hardcastle JD, Chamberlain JO, Robinson MH, et al. Randomised controlled trial of faecal-occult-blood screening for colorectal cancer. Lancet. 1996;348(9040):1472–7.
Selby JV, Friedman GD, Quesenberry Jr CP, Weiss NS. A case-control study of screening sigmoidoscopy and mortality from colorectal cancer. N Engl J Med. 1992;326(10):653–7.
Winawer SJ, Zauber AG, Ho MN, et al. Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. N Engl J Med. 1993;329(27):1977–81.
Lieberman DA, Holub J, Eisen G, Kraemer D, Morris CD. Utilization of colonoscopy in the United States: results from a national consortium. Gastrointest Endosc. 2005;62(6):875–83.
Harewood GC, Lieberman DA. Colonoscopy practice patterns since introduction of medicare coverage for average-risk screening. Clin Gastroenterol Hepatol. 2004;2(1):72–7.
Hall KE, Proctor DD, Fisher L, Rose S. American gastroenterological association future trends committee report: effects of aging of the population on gastroenterology practice, Âeducation, and research. Gastroenterology. 2005;129(4):1305–38.
Khanna PB. Colonoscopy in the elderly. J Clin Exp Gerontol. 1987;9(3):215–29.
Bat L, Pines A, Shemesh E, et al. Colonoscopy in patients aged 80 years or older and its contribution to the evaluation of rectal bleeding. Postgrad Med J. 1992;68(799):355–8.
Duncan JE, Sweeney WB, Trudel JL, Madoff RD, Mellgren AF. Colonoscopy in the elderly: low risk, low yield in asymptomatic patients. Dis Colon Rectum. 2006;49(5):646–51.
Ure T, Dehghan K, Vernava III AM, Longo WE, Andrus CA, Daniel GL. Colonoscopy in the elderly. Low risk, high yield. Surg Endosc. 1995;9(5):505–8.
Chatrenet P, Friocourt P, Ramain JP, Cherrier M, Maillard JB. Colonoscopy in the elderly: a study of 200 cases. Eur J Med. 1993;2(7):411–3.
Sardinha TC, Nogueras JJ, Ehrenpreis ED, et al. Colonoscopy in octogenarians: a review of 428 cases. Int J Colorectal Dis. 1999;14(3):172–6.
Stevens T, Burke CA. Colonoscopy screening in the elderly: when to stop? Am J Gastroenterol. 2003;98(8):1881–5.
Ransohoff DF, Lang CA. Sigmoidoscopic screening in the 1990s. JAMA. 1993;269(10):1278–81.
Miller KM, Waye JD. Approach to colon polyps in the elderly. Am J Gastroenterol. 2000;95(5):1147–51.
Miller K, Waye JD. Colorectal polyps in the elderly: what should be done? Drugs Aging. 2002;19(6):393–404.
Koretz RL. Polyp surveillance in patients with limited life expectancy. JAMA. 1996;275(4):327.
Arora A, Singh P. Colonoscopy in patients 80 years of age and older is safe, with high success rate and diagnostic yield. Gastrointest Endosc. 2004;60(3):408–13.
Froehlich F, Wietlisbach V, Gonvers JJ, Burnand B, Vader JP. Impact of colonic cleansing on quality and diagnostic yield of colonoscopy: the European Panel of Appropriateness of Gastrointestinal Endoscopy European multicenter study. Gastrointest Endosc. 2005;61(3):378–84.
Lukens FJ, Loeb DS, Machicao VI, Achem SR, Picco MF. Colonoscopy in octogenarians: a prospective outpatient study. Am J Gastroenterol. 2002;97(7):1722–5.
Warren JL, Klabunde CN, Mariotto AB, et al. Adverse events after outpatient colonoscopy in the Medicare population. Ann Intern Med. 2009;150(12):849–857; W152.
Rich JS, Black WC. When should we stop screening? Eff Clin Pract. 2000;3(2):78–84.
Wagner JL, Herdman RC, Wadhwa S. Cost effectiveness of colorectal cancer screening in the elderly. Ann Intern Med. 1991;115(10):807–17.
Walter LC, Covinsky KE. Cancer screening in elderly patients: a framework for individualized decision making. JAMA. 2001;285(21):2750–6.
Ko CW, Sonnenberg A. Comparing risks and benefits of colorectal cancer screening in elderly patients. Gastroenterology. 2005;129(4):1163–70.
Gross CP, McAvay GJ, Krumholz HM, Paltiel AD, Bhasin D, Tinetti ME. The effect of age and chronic illness on life expectancy after a diagnosis of colorectal cancer: implications for screening. Ann Intern Med. 2006;145(9):646–53.
Kahi CJ, Azzouz F, Juliar BE, Imperiale TF. Survival of elderly persons undergoing colonoscopy: implications for colorectal cancer screening and surveillance. Gastrointest Endosc. 2007;66(3):544–50.
Lin OS, Kozarek RA, Schembre DB, et al. Screening colonoscopy in very elderly patients: prevalence of neoplasia and estimated impact on life expectancy. JAMA. 2006;295(20):2357–65.
Fisher DA, Judd L, Sanford NS. Inappropriate colorectal cancer screening: findings and Âimplications. Am J Gastroenterol. 2005;100(11):2526–30.
Fisher DA, Galanko J, Dudley TK, Shaheen NJ. Impact of comorbidity on colorectal cancer screening in the veterans healthcare system. Clin Gastroenterol Hepatol. 2007;5(8):991–6.
Sultan S, Conway J, Edelman D, Dudley T, Provenzale D. Colorectal cancer screening in young patients with poor health and severe comorbidity. Arch Intern Med. 2006;166(20):2209–14.
Walter LC, Lindquist K, Nugent S, et al. Impact of age and comorbidity on colorectal cancer screening among older veterans. Ann Intern Med. 2009;150(7):465–73.
Kahi CJ, van Ryn M, Juliar B, Stuart JS, Imperiale TF. Provider recommendations for colorectal cancer screening in elderly veterans. J Gen Intern Med. 2009;24(12):1263–8.
Lewis CL, Moore CG, Golin CE, Griffith J, Tytell-Brenner A, Pignone MP. Resident physicians’ life expectancy estimates and colon cancer screening recommendations in elderly patients. Med Decis Making. 2008;28(2):254–61.
Cooper GS, Fortinsky RH, Hapke R, Landefeld CS. Primary care physician recommendations for colorectal cancer screening. Patient and practitioner factors. Arch Intern Med. 1997;157(17):1946–50.
Hoffman RM, Walter LC. Colorectal cancer screening in the elderly: the need for informed decision making. J Gen Intern Med. 2009;24(12):1336–7.
USPSTF. Screening for Colorectal Cancer: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med. 2008;149(9):627–37.
Zauber AG, Lansdorp-Vogelaar I, Knudsen AB, Wilschut J, van Ballegooijen M, Kuntz KM. Evaluating test strategies for colorectal cancer screening: a decision analysis for the U.S. Preventive Services Task Force. Ann Intern Med. 2008;149(4):659–69.
Walter LC, Lewis CL, Barton MB. Screening for colorectal, breast, and cervical cancer in the elderly: a review of the evidence. Am J Med. 2005;118(10):1078–86.
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Kahi, C.J. (2011). Screening for Colorectal Cancer in the Elderly. In: Anderson, MD, J., Kahi, MD, C. (eds) Colorectal Cancer Screening. Clinical Gastroenterology. Humana Press. https://doi.org/10.1007/978-1-60761-398-5_11
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