Copyright ©The Author(s) 2022.
World J Gastrointest Oncol. Jun 15, 2022; 14(6): 1086-1102
Published online Jun 15, 2022. doi: 10.4251/wjgo.v14.i6.1086
Table 1 Comments on colorectal cancer screening across professional organizations
Professional organization
Recommended ages for screening
Other considerations
American College of Gastroenterology (2021)50-75Screening after age 75 should be considered on an individualized basis; providers must engage in shared decision making
United States Preventive Services Task Force (2021) 45-75Screening adults aged 76-85 should be conducted on an individualized basis; do not screen adults age 86 years and above
United States Multi-Society Task Force on Colorectal Cancer (2021)45-75Consider discontinuation when persons up to date with screening, who have prior negative screening reach age 75 or have < 10 yr of life expectancy. Persons without prior screening should be considered for screening up to age 85, depending on age and comorbidities.
Canadian Task Force on Preventive Health Care (2016)50-74Recommend not screening adults aged 75 yr and older. (Weak recommendation; low-quality evidence)
American College of Physicians (2019)50-75Discontinue screening in average-risk adults older than 75 yr or in adults with a life expectancy of 10 yr or less
American Cancer Society (2018)45-75Screening adults aged 76-85 should be conducted on an individualized basis; screening discouraged above age 85
Table 2 Charlson comorbidity index conditions and scoring
Age< 50, 50-59, 60-69, 70-79, 80+0, +1, +2, +3, +4
Myocardial infarctionYes/no+1
CVA or TIAYes/no+1
Connective tissue diseaseYes/no+1
Peptic ulcer diseaseYes/no+1
Liver diseaseNone/mild/severe+1 (mild), +3 (moderate-severe)
Diabetes mellitusNone or diet controlled /uncomplicated/end-organ damage+1 (uncomplicated), +2 (end-organ damage)
Solid tumorNone/localized/metastatic+2 (local), +6 (metastatic)
Table 3 Colonoscopy-associated risks in older adults
Associated problems
PerforationBleed, infection, necrotic bowelEndoscopic technique (carbon dioxide insufflation, use of pediatric endoscopic equipment, careful navigation of diverticular disease), adequate bowel preparation
BleedingPost-polypectomy bleedHemoclip placement for bleeding prevention when appropriate, diluted epinephrine injection, use of detachable snare, thermal coagulation
Cardiovascular eventArrythmiaMedication review, screen for high-risk medications, confirm dosing appropriate for renal function; adjustment of anesthesia
Anticoagulation therapy interruptionRisk of thrombosis, MI, CVALiaise with prescribing physician; avoid colonoscopy during high-risk period; avoid interruption if possible
DeliriumCognitive impairmentRisk assessment; optimize medication list, avoid holding medications with withdrawal potential on morning of procedure
Medication interactionPolypharmacy increases sensitivity to anesthesiaMedication review; adjustment of anesthesia
DehydrationElectrolyte disturbancesAppropriate counseling prior to colonoscopy prep; caretaker supervision to ensure patient safety during prep