The fourth leading cause of cancer and the second leading cause of cancer mortality in the United States is colorectal cancer. Your risk for developing colorectal cancer increases as you age. Consider the following statistics:
Colonoscopies, both screening and diagnostic, are often regularly performed in the very elderly because of this increased risk of developing and dying from colon cancer.
Yet, this age group is also at a high risk for developing serious complications before and during a colonoscopy due to the bowel preparation and invasive nature of the procedure itself. Because of this, physicians use a carefully weighed system when deciding if their older patients should undergo colon cancer screening. Doctors understand that the very elderly have a limited amount of years left in their life span and must weigh the risk of them developing cancer with the risk of complications from a colonoscopy.
If you are concerned about the risks of a colonoscopy complication for yourself or a loved one who is elderly, this article will help to inform you about complications that are unique to the elderly and address the possible dangers that involve a geriatric colonoscopy.
The risks of complications from a colonoscopy definitively increase as you age:
The American Cancer Society recommends that people at an average risk for colorectal cancer begin screening by at least 50 years of age and stop screening after the age of 75. One of the reasons this society recommends people to stop screening for colon cancer after the age of 75 is because of the increased risk for developing a serious complication before, during, and after the procedure. Individuals who are over the age of 75 have twice the risk of developing a complication when compared to people between the ages of 50 and 74.
Common complications that occur during or after a colonoscopy include:
The primary reason that the risk for a complication increases with age is the comorbidities that an individual brings into the doctor’s office. More specifically, patients over the age of 80 are at a much higher risk for a complication if they have a medical history of diabetes or cardiovascular disease. Other comorbidities common in elderly patient that increase the risk for a colonoscopy complication include:
The US Preventive Services Task Force guidelines recommend against patients older than 85 years of age getting screened for colorectal cancer. There are several reasons why the Task Force has determined that elderly patients do not benefit from a colonoscopy screening when compared to younger individuals. Primarily, however, it is because physicians conclude that the risk of screening-related complications is substantially higher than the benefit from screening when considering the following:
For physicians, the decision to screen for colon cancer may be determined dependent on their patient as an individual. A healthy 85-year-old with no comorbidities may benefit from a colon cancer screening due to the patient’s increased risk of developing precancerous polyps (adenomas) in this age group. Colorectal cancer is highly treatable in its earliest stages by detection and removal of polyps found during a colonoscopy. Older patients have a better chance of surviving the treatment if a cancer is caught early than enduring the intense treatment regime that involves more advanced stages of cancer.
Yet, for another 85 year old with significant comorbidities (such as advanced dementia, cardiovascular diseases, and chronic kidney disease) which can shorten the expected lifespan of an individual over the age of 75, the risk of a colonoscopy complications may begin to outweigh the risk of colon cancer.
If you are older than the age of 75 and are concerned about your risk for colon cancer, be open with your physician and discuss your options. There are several non invasive colon screenings that do not put you at risk for a complication that may be used as an alternative to a colonoscopy.
Causado-Calo, N.., et., al. (2020, June 25). Association between age and complications after outpatient colonoscopy. Gastroenterology and Hepatology, 3(6). Retrieved from JAMA Network Open:https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2767639
Holland, K.(2018, June 26). Infection rates after colonoscopies up to 100 times higher than once thought. Retrieved from Healthline: https://www.healthline.com/health-news/infection-rates-after-colonoscopies
Lin, O. S. (2014, June 16). Performing colonoscopy in elderly and very elderly patients: Risks, costs and benefits. World Journal of Gastrointestinal Endoscopy, 6(6), 220-226. Retrieved from PMC: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4055990/
Neilson, L. J., Thirugnanasothy, S., Rees, C. J. (2018, September) Colonoscopy in the very elderly. British Medical Bulletin, 127(1), 33–41. https://academic.oup.com/bmb/article/127/1/33/5032139
Shaukat, A., et., al. (2021, March 01). ACG clinical guidelines: Colorectal screening 2021. American Journal of Gastroenterology, 116(3), 458-479. Retrieved from PubMed: https://pubmed.ncbi.nlm.nih.gov/33657038/
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