ACG: Colonoscopy's Benefits Extend to 80 and Beyond

PHILADELPHIA, Oct. 17 -- The benefits of screening colonoscopy extend to patients 80 and older, according to two studies reported here.Detection of asymptomatic early-stage colon cancer conferred a significant (P<0.005) survival advantage through age 85, Emily Singh, M.D., of the Scripps Clinic in La Jolla, Calif., said at the American College of Gastroenterology meeting.
In contrast, disease stage at diagnosis did not influence survival in symptomatic patients.
"The survival in asymptomatic patients results extend from ages 40 through 84 years," said Dr. Singh. "Recognizing that the average life expectancy at 80 years, without significant comorbidities, is nine years, we conclude that there is a role for screening colonoscopy in patients without significant comorbidities at least to age 85."
Roy Yen, M.D.University of BuffaloBuffalo, NY A second study provided additional support for screening colonoscopy in patients ages 80 and older. The study showed similar survival following screening colonoscopy for patients ages 70 through 79 and those ages 80 and older, said Roy Yen, M.D., of the University of Buffalo in New York.
Screening colonoscopy for older patients remains contentious, as no clear evidence or consensus exists to show that the benefits of screening end at a certain age, said Dr. Singh. Without adequate data, the controversy will likely intensify as the population ages. The population ages 65 and older is expected to exceed 72 million by 2030, more than double the number in 2000.
Dr. Singh and colleagues retrospectively analyzed data from a cancer registry to identify patients diagnosed with pathology-proven colorectal cancer from January 2000 through December 2005. The analysis identified 356 patients, 113 of them classified as asymptomatic and 242 or symptomatic.
The asymptomatic group comprised 81 patients with early-stage disease (0-IIB) and 32 with late-stage disease (III-IV). The symptomatic patients consisted of 130 with early disease and 113 with late-stage disease.
With a median follow-up of 2.5 years from diagnosis, detection of early-stage disease resulted in a significant survival advantage across all ages in the asymptomatic group. Men and women benefited, regardless of age.
Similar findings emerged from the Buffalo study, which was derived from data on 587 screening or surveillance colonoscopies. The study population included 58 patients who were 80 or older at the time of their colonoscopy procedures.
Colonoscopy detected significantly more adenomas in older patients (41.1% versus 26.0%, P=0.02) and more colon cancers (7.1% versus 2.1%, P=0.02). Older patients also had more proximal adenomas (28.6% versus 11.7%, P<0.01) and proximal colon cancer (5.4% versus 1.3%, P=0.03).
During 2.5-year follow-up after colonoscopy, 75.2% of the older patients were alive, which was not significantly different from the 83.2% survival observed in patients ages 70 to 79.
"These results suggest that patients 80 years and older may still benefit from screening colonoscopy," said Dr. Yen. "However, the findings need to be confirmed in additional studies."
Dr. Singh, Dr. Yen, and their coinvestigators declared no conflicts.Primary source: American College of GastroenterologySource reference: Yen RD et al. "Screening colonoscopy in patients older than 80 years." American College of Gastroenterology Annual Meeting and Postgraduate Course. Oct. 12-17, 2007. Philadelphia. Abstract 1000. Additional source: American College of GastroenterologySource reference: Singh EG et al. "Screening colonoscopy in the elderly. Is it worthwhile?" American College of Gastroenterology Annual Meeting and Postgraduate Course. Oct. 12-17, 2007. Philadelphia. Abstract 1001.