March 21, 2023 – Most of the time, when a polyp is discovered during a colonoscopy of an older person, it is unlikely that a polyp or colon cancer of concern will be discovered during a future surveillance scan. Still, most patients are advised to repeat colonoscopy even though they aren’t expected to live very long, according to a new study.
“Given the lack of clear guidelines on when to stop colonoscopy in elderly patients, I am not surprised that physicians recommend monitoring even in patients with low life expectancies,” said Ziad Gellad, MD. , MPH, from Duke University Medical Center in Durham, North Carolina. , who did not participate in the research.
“These are nuanced decisions that require shared decision-making. It’s not easy to tell patients they’re too old to get preventative care, especially patients where your only interaction is the procedure itself,” Gellad said.
Current guidelines recommend that physicians and patients make decisions about repeat colonoscopy in older adults with anterior polyps, weighing the potential benefits (identification and removal of polyps significant to prevent cancer) against the burdens and to potential harm, such as bleeding.
Although most colon polyps are not harmful, a subset of polyps, if they develop, have the potential to turn into cancer, a transformation that can take 10 to 15 years. This long timeline highlights the importance of considering life expectancy when deciding which patients should undergo a repeat colonoscopy.
The new study involved nearly 10,000 adults aged 65 and over undergoing surveillance colonoscopy due to an anterior polyp. Fewer than 1 in 10 of these people had advanced polyps or colorectal cancer on repeat colonoscopy.
Yet the vast majority (87%) of people whose doctor recommended stopping or continuing colonoscopy were advised to return for another procedure at some point — even when they had no meaningful colonoscopy results. or a limited life expectancy, including less than 5 years.
In some cases, the recommended time to repeat the colonoscopy was longer than the individual’s life expectancy.
Complications during colonoscopies occur in about 26 out of 1,000 people, nearly 10 times more than the potential benefits seen in their study in terms of identifying cancer.
These results “could help refine decision-making” about the potential benefits and harms of continuing or stopping surveillance colonoscopy in older adults with a history of polyps, write the investigators, led by Audrey Calderwood , MD, with Dartmouth Hitchcock Medical Center in Lebanon, NH.
Based on their findings, they believe that older people who are expected to live less than 5 years longer should skip surveillance colonoscopy. The same is true for individuals whose life expectancy is between 5 and less than 10 years and who only have “low risk” polyps.
For the healthy senior with a life expectancy of 10 years or more and recent “advanced” polyps, they suggest that the doctor provide a referral for future surveillance colonoscopy with a caveat that the final decision depends on health and priorities when the colonoscopy is due.
