Commentary by Andrew McKinstry MD, PGY-1 (reviewed by Michael Poles, MD, Associate Editor Clinical Correlations, Assistant Professor of Medicine, Section of Gastroenterology)
Hot on the heels of its recommendation in August against routine screening for prostate cancer in men over 75, the US Preventive Services Task Force has issued recommendations against routine screening for colorectal cancer in patients over the age of 75- Yes, you read that correctly, NO routine screening for colorectal cancer past age 75. In a report updating their recommendations from 2002, the task force concluded that the significant lead time between early detection/treatment and any witnessed mortality benefit resulted in a sharp decline in the benefits of early detection and intervention seen after age 75. This benefit decline is consistent with what is known of the natural history of the disease, in which the transition from precursor lesion to malignancy occurs over a period of 10-15 years, by which time someone over the age of 75 would be likely to succumb to mortality of a different source.
In the over-75 population, the task force noted potential increased harms of screening tests and procedures, from complications from the bowel prep and sedation, to bowel perforation during colonoscopy, resulting in little to no net benefit for routine screening. A notable exception is very high-risk populations (patients with Lynch syndrome, familial adenomatous polyposis, or inflammatory bowel disease) where the task force recommended that routine screening extend until age 85. Of note, the above recommendations apply to current common screening methods including high sensity FOBT, sigmoidoscopy, or colonoscopy. The task force did not find sufficient evidence to assess the risk/benefit ratio of the newer modalities of CT colonography and fecal DNA testing as colorectal cancer screening tools.