Dear OncoLink "Ask The Experts,"
My 82 year old cousin is due for colonoscopy. The last one was 8 years ago. Her previous 2 colonoscopy procedures revealed precancerous polyps each time. There is no family history of colon cancer. She had a mastectomy 45 years ago. She has diabetes. Is a colonoscopy indicated at her age, or does the risk of perforation preclude doing the procedure? She is in a small town and was discouraged from having the procedure by her primary care doc. Should she seek a 2nd opinion?
Jenia Jenab-Wolcott, MD, PhD, Gastroenterologist at the Hospital of the University of Pennsylvania, responds:
Although the prevalence of colorectal cancers (CRC) continues to increase as we get older, the age to stop screening is unknown. The decision for screening colonoscopy in individuals over 70 years of age should depend on their general health status, anticipated life expectancy, risk for colorectal cancer (based on family history and personal history of colonic cancer and polyps), and personal preferences. It should be kept in mind that patients with life expectancy <5 yrs are generally not felt to benefit from CRC screening and that colonoscopy carries an increased risk of procedure related complications in the elderly (especially those with heart or lung disease, diabetes, or history of stroke).
The U.S. Preventive Services Task Force guidelines recommends that patients over age 85 not be screened, and recommends against screening in adults 76 to 85 years, unless there are individual considerations that favor screening.
This question and answer was part of the OncoLink Brown Bag Chat Series, Colorectal cancer Webchat. View the entire transcript here.