Colorectal Cancer Screening in the Elderly: Is Age Just a Number?

• Published in: Clinical colorectal cancer 2022-06, Vol.21 (2), p.e113-e116
• Main Authors: Alswealmeen, Waed, Sadri, Lili, Perrotti, Gabrielle, Heilman, Jaclyn, Bakshi, Kirran, Kim, Soo Y., Zebley, David M., Fassler, Steven A.
• Format: Article
• Language: English
• Subjects: Advanced Elderly; Aged; Aged, 80 and over; Canada - epidemiology; Child; Colonoscopy; Colorectal Cancer; Colorectal cancer screening; Colorectal Neoplasms - diagnosis; Colorectal Neoplasms - epidemiology; Colorectal Neoplasms - surgery; Early Detection of Cancer; Elderly; Female; Frailty; Frailty - diagnosis; Frailty - epidemiology; Humans; Male; Postoperative Complications - epidemiology; Retrospective Studies; Risk Factors
• ISSN: 1533-0028; 1938-0674
• DOI: 10.1016/j.clcc.2021.11.011

•Screening guidelines for colorectal cancer have yet to be established in patients greater than 75 years of age.•Patients greater 75 years who underwent colonoscopy for symptomatic colon cancer had a low mortality.•Utilizing frailty indices to identify screening patterns for patients beyond 75 years could prove beneficial. Colorectal cancer screening improved outcomes for patients diagnosed between the age of 45-75. Present life expectancy is beyond this limit, yet there are no guidelines for these ages. We aim to identify outcomes after screening and intervention in patients ≥75 years and correlate with frailty. Records between 2011 and 2019 were queried. Patients ≥75 screened and treated for colorectal cancer were included. Patient demographics, perioperative mortality, age at last colonoscopy and frailty score were calculated. A Modified Frailty Index from the Canadian Study of Health and Aging Frailty Index was used. A score of 1 to 11 was calculated based on patient comorbidities. The MFI was assigned from 0 to 11: 0 signified absence of frailty and 11 indicated maximum frailty. Of 179 patients were identified, 46.3% males. 171(95%) had elective and 8 (5%) had emergent surgery. The average age was 81.8 years. All colonoscopies were performed for symptoms. A modified frailty index was retrospectively calculated; 75% of patients scored between 0 and 2 and 1% scored >6. Older patients who underwent colonoscopy and surgery for symptomatic colon cancer had a low mortality, 2%. The average age was 6.8 years older than the recommended cutoff for colonoscopy screening. Most patients scored 0 to 2 on the modified frailty index, suggesting that not only are older patients more fit than previously thought, but also able to tolerate colorectal interventions more liberally. Utilizing frailty indices to identify screening patterns beyond 75 years of age might prove beneficial for this patient population. Further studies are recommended. Colorectal cancer screening has improved outcomes for patients diagnosed between 45 and 75 years. The average American life expectancy is 82. There are no guidelines for screening patients ≥75 years. We examined 179 patients (average age 82) who underwent surgery after a positive colonoscopy and the surgical mortality was ≤2%. We found that utilizing frailty indices to identify screening patterns in patients ≥75 could prove beneficial for predicting outcomes after colonoscopy and surgery.