Review
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
Condition
Value
Score
Age< 50, 50-59, 60-69, 70-79, 80+0, +1, +2, +3, +4
Myocardial infarctionYes/no+1
CHFYes/no+1
PVDYes/no+1
CVA or TIAYes/no+1
DementiaYes/no+1
COPDYes/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)
HemiplegiaYes/no+2
CKDYes/no+2
Solid tumorNone/localized/metastatic+2 (local), +6 (metastatic)
LeukemiaYes/no+2
LymphomaYes/no+2
AIDSYes/no+6
Table 3 Colonoscopy-associated risks in older adults
Risk
Associated problems
Mitigation
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