In a prospective cohort study reported in JAMA Oncology, Ma et al found that lower endoscopy colorectal cancer screening in individuals older than age 75 was associated with reduced colorectal cancer incidence and mortality, although no colorectal cancer mortality benefit was observed in those with cardiovascular disease or significant comorbidities.
As noted by the investigators, “At present, the U.S. Preventive Services Task Force recommends continuing colorectal cancer screening until 75 years of age and individualized decision-making for adults older than 75 years, while accounting for a patient’s overall health and screening history. However, scant data exist to support these recommendations.”
Study Details
The study involved data on health-care professionals participating in the prospective Nurses’ Health Study (January 1988–June 2016) and Health Professionals Follow-up Study (January 1988–January 2016). History of screening sigmoidoscopy or colonoscopy in individuals with routine/average risk or positive family history was ascertained from assessments performed every 2 years in the two cohorts.
In this cohort study, endoscopy among individuals older than 75 years was associated with lower risk of colorectal cancer incidence and colorectal cancer–related mortality. These data support continuation of screening after 75 years of age among individuals without significant comorbidities.— Ma et al
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Key Findings
Among 56,374 participants who reached age 75 during follow-up without a diagnosis of colorectal cancer (36.8% men and 63.2% women), 661 subsequent colorectal cancer cases and 323 subsequent colorectal cancer–related deaths were identified.
On multivariate analysis, screening endoscopy vs no screening after age 75 was associated with reduced risk of colorectal cancer (hazard ratio [HR] = 0.61, 95% confidence interval [CI] = 0.51–0.74) and colorectal cancer–related mortality (HR = 0.60, 95% CI = 0.46–0.78), irrespective of participant screening history.
Among participants who underwent screening before age 75, hazard ratios for screening vs no screening after age 75 were 0.67 (95% CI = 0.50–0.89) for colorectal cancer incidence and 0.58 (95% CI = 0.38–0.87) for colorectal cancer–related mortality. Among participants with no screening history prior to age 75, hazard ratios for screening vs no screening after age 75 were 0.51 (95% CI = 0.37–0.70) for colorectal cancer incidence and 0.63 (95% CI = 0.43–0.93) for colorectal cancer–related mortality.
In subgroup analyses, no reduction in colorectal cancer–related mortality was observed with screening vs no screening after age 75, independent of screening history among participants with cardiovascular disease at age 75 (HR = 1.18, 95% CI = 0.59–2.35) or among those with three or more comorbidities (including cardiovascular disease, hypertension, hypercholesterolemia, and diabetes) at age 75 (HR = 1.17, 95% CI = 0.57–2.43). No effect on benefits of screening was observed for family history vs no family history of colorectal cancer.
The investigators concluded, “In this cohort study, endoscopy among individuals older than 75 years was associated with lower risk of colorectal cancer incidence and colorectal cancer–related mortality. These data support continuation of screening after 75 years of age among individuals without significant comorbidities.”
Mingyang Song, MD, ScD, of the Department of Epidemiology, Harvard T.H. Chan School of Public Health, and Andrew T. Chan, MD, MPH, of Massachusetts General Hospital, Harvard Medical School, are the corresponding authors for the JAMA Oncology article.
Disclosure: The study was supported by grants from the National Institutes of Health and others. For full disclosures of the study authors, visit jamanetwork.com.
