Review
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Jun 15, 2022; 14(6): 1086-1102
Published online Jun 15, 2022. doi: 10.4251/wjgo.v14.i6.1086
Practical considerations for colorectal cancer screening in older adults
Dana Gornick, Anusri Kadakuntla, Alexa Trovato, Rebecca Stetzer, Micheal Tadros
Dana Gornick, Anusri Kadakuntla, Alexa Trovato, Albany Medical College, Albany Medical College, Albany, NY 12208, United States
Rebecca Stetzer, Division of Geriatrics, Albany Medical Center, Albany, NY 12208, United States
Micheal Tadros, Division of Gastroenterology, Albany Medical Center, Albany, NY 12208, United States
Author contributions: Gornick D, Kadakuntla A, and Trovato A wrote the paper; Gornick D and Kadakuntla A contributed to the figures and tables; Gornick D, Stetzer R, and Tadros M made critical revisions; and Tadros M approved final version of manuscript to be published.
Conflict-of-interest statement: The authors disclose no conflicts of interest or external funding for this publication.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Micheal Tadros, FACG, MD, Associate Professor, Doctor, Division of Gastroenterology, Albany Medical Center, 43 New Scotland Avenue, Albany, NY 12208, United States. tadrosm1@amc.edu
Received: December 13, 2021
Peer-review started: December 13, 2021
First decision: March 13, 2022
Revised: March 23, 2022
Accepted: April 30, 2022
Article in press: April 30, 2022
Published online: June 15, 2022
Abstract

Recent guidelines recommend that colorectal cancer (CRC) screening after age 75 be considered on an individualized basis, and discourage screening for people over 85 due to competing causes of mortality. Given the heterogeneity in the health of older individuals, and lack of data within current guidelines for personalized CRC screening approaches, there remains a need for a clearer framework to inform clinical decision-making. A revision of the current approach to CRC screening in older adults is even more compelling given the improvements in CRC treatment, post-treatment survival, and increasing life expectancy in the population. In this review, we aim to examine the personalization of CRC screening cessation based on specific factors influencing life and health expectancy such as comorbidity, frailty, and cognitive status. We will also review screening modalities and endoscopic technique for minimizing risk, the risks of screening unique to older adults, and CRC treatment outcomes in older patients, in order to provide important information to aid CRC screening decisions for this age group. This review article offers a unique approach to this topic from both the gastroenterologist and geriatrician perspective by reviewing the use of specific clinical assessment tools, and addressing technical aspects of screening colonoscopy and periprocedural management to mitigate screening-related complications.

Keywords: Colorectal cancer, Colonoscopy, Cancer screening, Early detection of cancer, Aged, Elderly

Core Tip: Clinical guidelines do not recommend colorectal cancer (CRC) screening after age 75. Given the improvements in CRC treatment and post-treatment survival, and increasing life expectancy in the population, the current approach to CRC screening in older adults needs to be revised. This review examines the personalization of CRC screening in older individuals based on specific factors influencing life and health expectancy. Screening modalities, techniques, and risks are also discussed.