Colon Cancer Screening May Be Worthwhile In Previously Unscreened Elderly

MedicalResearch.com Interview with:
Frank van Hees MSc
Erasmus University Medical Center
Rotterdam, the Netherlands and
Ann G. Zauber PhD
Memorial Sloan Kettering Cancer Center, New York

MedicalResearch: What are the main findings of the study?

Answer: The main finding of our study is that colorectal cancer screening of individuals without previous screening is worthwhile well beyond age 75, which is the recommended age to stop screening in individuals with an adequate screening history. The exact age up to which screening should be considered in unscreened elderly depends on an individual’s health status: in healthy individuals screening remains worthwhile up to age 86, whereas in individuals with a severe illness, such as heart failure, screening remains worthwhile up to age 80.

MedicalResearch: Were any of the findings unexpected?

Answer: In adequately screened individuals with an average life-expectancy, screening has been shown to be worthwhile up to age 75. Since individuals without previous screening are at higher risk for colorectal cancer than adequately screened individuals, we expected screening to be cost-effective up to a more advanced age in these individuals. However, up to what age screening would remain cost-effective was unknown to us. We had not anticipated that it would remain cost-effective up to age 86 for healthy elderly without prior screening.

MedicalResearch: What should clinicians and patients take away from your report?

Answer: They should take away that colorectal cancer screening of previously unscreened individuals is worthwhile well beyond age 75 and, more in general, that decisions on screening should not be based solely on age, but also on factors such as the individual’s screening history and health status.

MedicalResearch: What recommendations do you have for future research as a result of this study?

Answer: We recognize that decisions on colorectal cancer screening should not be based on cost-effectiveness criteria only, but also on patient preferences. To achieve this, decision aids that generate personalized information on the benefits, burden, and harms of screening are required.

Citation:

Should Colorectal Cancer Screening Be Considered in Elderly Persons
Without Previous Screening? A Cost-Effectiveness Analysis
Frank van Hees, MSc; J. Dik F. Habbema, PhD; Reinier G. Meester, MSc; Iris Lansdorp-Vogelaar, PhD; Marjolein van Ballegooijen, MD, PhD*;and Ann G. Zauber, PhD*
Ann Intern Med. 2014;160:750-759.

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