March 21, 2023 – If a colonoscopy in older people finds a polyp, usually a subsequent follow-up exam is unlikely to also discover a worrisome polyp or colon cancer. Yet most patients are advised to repeat the colonoscopy even in the event that they will not be expected to live long, a brand new study shows.
“Given the lack of clear guidelines on when to stop colonoscopy in older patients, I'm not surprised that physicians recommend surveillance even in patients with a low life expectancy,” said Ziad Gellad, MD, MPH, of Duke University Medical Center in Durham, NC, who was not involved within the study.
“These are nuanced decisions that require shared decision-making. It's not easy to tell patients they're too old for screening, especially patients you only interact with during the procedure itself,” Gellad said.
Current guidelines recommend that when deciding whether to repeat colonoscopy in older adults with a history of polyps, physicians and patients weigh the potential advantages (identification and removal of necessary polyps to stop cancer) against the burdens and potential harms, equivalent to bleeding.
While most colon polyps will not be harmful, some polyps can become cancer as they grow. This development can take 10 to fifteen years. This long timeframe underscores the importance of considering life expectancy when deciding which patients should undergo a repeat colonoscopy.
The latest study involved nearly 10,000 adults ages 65 and older who had a follow-up colonoscopy for a previous polyp. Fewer than 1 in 10 of those people were found to have advanced polyps or colon cancer during a repeat colonoscopy.
Nevertheless, the overwhelming majority (87%) of people that were advised by their doctor to stop or proceed colonoscopy were advised to return sooner or later for one more procedure, even in the event that they had no significant findings on colonoscopy or had a limited life expectancy, sometimes lower than five years.
In some cases, the really helpful time until the following colonoscopy was longer than the person's life expectancy.
About 26 out of 1,000 people experience complications from a colonoscopy, which is sort of ten times greater than the potential profit the study suggests when it comes to cancer detection.
These findings “may help refine decision-making” regarding the potential advantages and harms of performing or withholding surveillance colonoscopy in older adults with a history of polyps, write the researchers, led by Audrey Calderwood, MD, of Dartmouth Hitchcock Medical Center in Lebanon, NH.
Based on their results, they imagine that older adults whose life expectancy is lower than five years shouldn’t undergo surveillance colonoscopy. The same applies to people whose life expectancy is between 5 and lower than 10 years and who only suffer from “low-risk” polyps.
In healthy older individuals with a life expectancy of ten years or more and up to date onset of “advanced” polyps, they recommend that the physician make a suggestion for future control colonoscopies, with the caveat that the ultimate decision is determined by the health status and priorities on the time of colonoscopy.