Colorectal cancer screening decisions should consider life expectancy

NEW YORK (Reuters Health) - Colorectal cancer screening decisions should give more attention to life expectancy and less attention to age, according to a report in the April 7th Annals of Internal Medicine.

"Colorectal cancer screening decisions need to be more thoughtful and individualized rather than rigidly based on age cutoffs," Dr. Louise C. Walter from the Veterans Affairs Medical Center, San Francisco, told Reuters Health. "A core principle of good medicine is to target interventions to patients for whom the potential benefits of an intervention outweigh the potential harms."

Dr. Walter and her colleagues evaluated 2-year screening incidences and 5-year mortality rates in older patients with severe comorbidities, for whom most guidelines agree that the risks of screening outweigh the benefits, and elderly patients without significant comorbidity, for whom guidelines do recommend screening.

Colorectal cancer screening decreased with advancing age, the authors report, but worsening comorbidity only weakly predicted the incidence of screening.

The incidence of screening did not fall below 30% even for elderly patients with severe comorbid conditions (except among homebound or demented patients), the researchers note, but the overall screening incidence was only about 50% even among patients predicted to live more than 5 years.

The number of outpatient visits to primary care, gastroenterology, or general surgery clinics at the VA Medical Center was one of the strongest predictors of screening, the investigators say.

"Age is not the most important factor to consider when estimating potential benefits and harms of screening," Dr. Walter concluded. "Rather, screening decisions should take an individualized approach that considers an older person's medical illnesses (e.g., dementia, congestive heart failure, end-stage renal disease) and their preferences to determine when to stop screening."

"We are currently conducting research to determine the real-world outcomes of colorectal cancer screening in patients according to their age and health," Dr. Walter added. "We hope that providing real-world data about the burdens and benefits of colorectal cancer screening in older patients with different levels of medical illness will allow for more informed screening decisions in this population."

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