(RxWiki News) Experts recommend that people stop getting screened for colorectal cancer after the age of 75. But that recommendation only applies to people who have been adequately screened — so what about those who have never been screened?
A recent study found that colorectal cancer screening was cost-effective in elderly people who had not been previously screened.
The researchers recommended that screening should continue past the age of 75 years old for those who haven't been screened before.
This study showed that screening was cost-effective until the age of 86 years old if the patient had no other health issues, until the age of 83 for people with some co-occurring health issues, and until 80 years old if the patient had severe co-occurring conditions.
"Tell your doctor if you haven’t been screened for colorectal cancer."
The senior authors of this study were Marjolein van Ballegooljen, MD, PhD, from Erasmus University Medical Center in Rotterdam, the Netherlands, and Ann G. Zauber, PhD, from Memorial Sloan Kettering Cancer Center in New York, New York.
The recommendations coming from this study apply only to older people between the ages of 76 and 90 years old who had not been previously screened for colorectal cancer and who were at average risk for colorectal cancer.
The researchers used a computer simulation to compare a group of 10 million elderly patients with no previous screening to a group of adequately screened elderly patients. These elderly people were divided into those with no comorbid conditions (secondary health problems), those with moderate comorbid conditions and those with serious comorbid conditions.
Each group received a one-time screening with colonoscopy, sigmoidoscopy or fecal immunochemical test (FIT).
A colonoscopy is an exam that uses a small camera attached to a tube to view the inside of the colon and rectum. A sigmoidoscopy is similar to a colonoscopy, but the exam only focuses on the lower part of the colon where it attaches to the rectum. A FIT involves collecting and analyzing a stool sample for blood.
Then, the researchers evaluated how cost-effective each method was for each age and status of comorbid conditions.
The cost-effectiveness was determined by considering financial costs, potential years of life gained and quality of life in years gained.
The findings showed that colorectal cancer screening was cost-effective up until the age of 86 years old in elderly patients with no comorbid conditions.
A colonoscopy screening in elderly patients with no comorbid conditions was found to be cost-effective up until 83 years old, sigmoidoscopy was cost-effective until 84 years old, and FIT was cost-effective until 85 and 86 years old.
For patients with some comorbid conditions, screening was cost-effective until the age of 83. Screening with colonoscopy for patients with some comorbid conditions was cost-effective until 80 years old, screening with sigmoidoscopy was cost-effective until 81 years old, and FIT was cost-effective until 82 and 83 years old.
The researchers discovered that elderly patients with no previous screening for colorectal cancer and with severe comorbid conditions could be screened up until the age of 80 years old.
Colonoscopy for those with severe comorbid conditions was cost-effective up until 77 years old, sigmoidoscopy was cost-effective until the age of 78, and FIT was cost-effective until the ages of 79 and 80 years old.
The findings also revealed that the effectiveness of colorectal screening in previously unscreened elderly people decreased as the patient’s age increased, whereas the financial cost of screening increased significantly as age increased.
For example, colonoscopy screening at age 76 was linked to a lifetime cost of $725,000 per 1,000 healthy people, whereas colonoscopy screening at age 90 was associated with a lifetime cost of $2,130,000 per 1,000 healthy people.
In an accompanying editorial, Amanda V. Clark, MD, and C. Seth Landefeld, MD, of the University of Alabama at Birmingham, concluded that colonoscopy should now be considered in every patient aged 75 and older who has not been screened for colorectal cancer.
This research was limited because the researchers did not analyze the patients according to sex or race, and the study population only consisted of people at average risk for colorectal cancer.
This study was published on June 2 in the Annals of Internal Medicine.
The National Cancer Institute provided funding.