Age cutoffs for colon cancer screening debated

By Will Boggs, MD

NEW YORK (Reuters Health) - Decisions about the advisability of colorectal cancer screening should give more attention to life expectancy and less attention to age, according to a new report.

"Colorectal cancer screening decisions need to be more thoughtful and individualized rather than rigidly based on age cutoffs," Dr. Louise C. Walter 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."

Walter, at the Veterans Affairs Medical Center, San Francisco, and her colleagues evaluated screening rates and mortality rates in two groups of older patients: those with numerous serious illnesses, for whom the risks of screening outweigh the benefits; and those without significant conditions, for whom guidelines do recommend screening.

Colorectal cancer screening decreased with advancing age, the team reports in the Annals of Internal Medicine.

However, rates of screening did not fall below 30 percent even for elderly patients with serious conditions, the researchers note. On the other hand, the overall screening rate was only about 50 percent among elderly patients expected to have a relatively long life expectancy.

"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."

SOURCE: Annals of Internal Medicine, April 7, 2009.