A new survey suggests that 40% of older adults think having an age cutoff for colon cancer screenings at 75 years old is unacceptable

Some Older Adults Find an Age Cutoff For Colon Cancer Screenings 'Unacceptable'—Here's Why Doctors Say It Exists Here's why experts set the guideline

• In a new survey, 40% of adults over 50 said an age cutoff for routine colorectal cancer screenings at 75 years old was “somewhat” or “very” unacceptable.
• Experts set this guideline because at age 75, the benefits of colorectal cancer screenings do not outweigh the risks.
• You can still get screened past age 75, and experts advise talking to your healthcare provider about the best recommendation for you.

Many older adults think they should still receive colon cancer screenings past the age of 75.

At least that’s the conclusion of a study published Dec. 3 in the journal JAMA Network Open, which found that 40% of adults over 50 surveyed found an age 75 cutoff for routine colon cancer screenings “somewhat” or “very” unacceptable. 

Though the study focused specifically on colon cancer, guidelines for that type fall under the umbrella of “colorectal cancer,” which is cancer that begins in either the colon or rectum. They suggest routine screenings like colonoscopies for the average-risk person beginning at ages 45 or 50 to increase the odds of catching it earlier, when it’s often most treatable.

But age 75 marks a turning point when testing risks outweigh benefits, experts say.

That’s why the U.S. Preventive Services Task Force and other groups call for individualized screenings starting at age 75 and for people to stop getting screened altogether at age 85. The American College of Physicians takes a stronger stance, recommending that routine screenings end at age 75 for average-risk adults with no symptoms of colorectal cancer and with a life expectancy of no more than 10 years.

But according to the new study, many older adults don’t agree with the age 75 cap for routine testing of colon cancer, which accounts for the second-highest number of cancer-related deaths in the U.S. when combined with rectal cancer mortality.

“More than anything else, this research shows that many older adults are deeply skeptical of messages that ask them to stop getting colon screening tests like colonoscopies,” said Brian J. Zikmund-Fisher, PhD, study co-author and a professor in the Department of Health Behavior and Healthy Equity at the University of Michigan School of Public Health.

“Yet, for some older adults, getting more colonoscopies would be more likely to harm the person than to help them,” he told Health. “Somehow, we need to figure out how to have that conversation openly and honestly with older adults.” 

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What the Research Found

Researchers analyzed responses from 1,302 people participating in the 2018 wave of the Health and Retirement Study, an ongoing study of about 20,000 U.S. adults aged 50 and older conducted by the University of Michigan. 

The study sample included 794 females and 508 males, and 23% had a limited estimated life expectancy based on the Lee Index, a risk calculator used to predict mortality.

Participants were asked whether guidelines to stop colon cancer screening past age 75 due to harms possibly outweighing the benefit of finding a new cancer were “very unacceptable,” “somewhat unacceptable,” “somewhat acceptable,” or “very acceptable.”

After their analysis, researchers discovered that 60% rated the guidelines as very or somewhat acceptable. In comparison, almost 40% said the guidelines were somewhat or very unacceptable.

Notably, estimated life expectancy didn’t affect the responses—39.2% of those with limited life expectancy and 39.7% with longer life expectancy found the guidelines unacceptable. 

Laura Brotzman, MPH, study co-author and a PhD candidate in the University of Michigan’s Department of Health Behavior and Health Equity, said that in interviews, some older adults revealed that they believe screening age caps are cost-saving measures that restrict individual choice and personalized care.

“Many older adults in these interviews believe that life expectancy is either irrelevant or too incomplete to guide cancer screening decisions,” Brotzman told Health. “They also tend to believe that the potential benefits of cancer screening outweigh potential harms or risks, and they express concerns about their personal life expectancy being estimated and used to deny them screening.”

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Why Are There Cancer Screening Age Caps?

The screening caps come down to the risks of screening outweighing the benefits, experts said. 

Though colonoscopies are routine, they still pose a potential danger. The procedure can cause bleeding and intestinal tears, and those risks increase after age 75 and further shoot up after 85, Theodore R. Levin, MD, a gastroenterologist, clinical lead for colorectal cancer screening, and research scientist at the Kaiser Permanente Division of Research in Northern California, told Health.

People over age 75 also have reduced life expectancy and a higher probability of dying from something other than colorectal cancer, like cardiovascular disease or other cancers, Philip A. Philip, MD, director of gastrointestinal oncology at Henry Ford Cancer Institute, told Health.

One study found that death from other causes was over 100 times more likely than death from colorectal cancer among 76- to 85-year-olds with a recent negative stool-based colorectal cancer screening test.

“The key argument is the fact that over age 75, the chances of someone having an illness or comorbidity that will result in their death is reasonably high,” Philip said, “and hence thinking of only colorectal cancer as a cause of death is not realistic in preventing death in general in those over 75.”

The reasoning behind recommended screening age caps for other cancers, such as cervical or breast, is similar, but the specific guidelines differ, Zikmund-Fisher pointed out. “The tradeoff between the benefits of further screening tests and the risks of doing so is different in each case,” he said.

Cancer Screening Considerations for Older Adults

Just because you’re over age 75 doesn’t mean you can’t ever get screened for colorectal cancer. The first step is to talk to your doctor about whether screening makes sense for you. “It’s important for patients to have honest discussions with their physician about their overall health, life care plans, and likelihood of benefitting from colorectal cancer screening,” Levin said.

When considering whether a screening would benefit you, experts say your doctor will likely consider your current health status and life expectancy. “Life expectancy is increasingly recognized as a more nuanced metric than age alone to guide cancer screening decisions for older adults,” Brotzman said.

Previous screening history is another key factor to consider, Levin said. While studies show those over age 75 who are up to date on screenings are much more likely to die from something other than colorectal cancer, “the calculation is much different for people who have not been screened consistently,” Levin said. “There may be much greater benefit to screening after 75 if people are not up to date with either colonoscopy or a fecal screening test.”

Edited by Health with a background in health, science, and investigative reporting. Previously, she wrote full time about parenting issues for the app Parent Lab. Before that, she worked as a reporter for National Geographic covering wildlife crime and exploitation." tabindex="0" data-inline-tooltip="true"> Jani Hall Jani Hall Jani Hall is a news editor for Health with a background in health, science, and investigative reporting. Previously, she wrote full time about parenting issues for the app Parent Lab. Before that, she worked as a reporter for National Geographic covering wildlife crime and exploitation. learn more

This story originally appeared on: Health News - Author:Cathy Nelson