The recommended age range for colorectal cancer screenings via colonoscopy in the U.S. is 45-75.
The benefits of colonoscopies are considered to be considerably diminished after this age. This is due to the risks involved with colonoscopy preparation, which can cause dehydration and electrolyte problems, bleeding and bowel perforation that can occur pre-procedure and pulmonary and cardiovascular complications that can transpire afterward.
But as Michael Rothberg, MD, and director of the Center for Value-Based Care Research at the Cleveland Clinic, said in an Aug. 26 article in Medscape Medical News life expectancy should be a key consideration in determining if a patient is "too old" to receive a colonoscopy.
"Taking the most extreme example, if you have six months to live, finding early-stage cancer is not going to help you," he said. But for others with more time or fewer comorbidities, it could be worth the risks.
In 2021, the U.S. Preventive Services Task Force upheld its 2016 recommendation of selective screening for those between 76 and 85 years old. In November 2023, the American Gastroenterological Association issued a clinical practice update that provided insight on risk stratification for CRC screenings in individuals who have had previously identified polyps. Per this recommendation, physicians should evaluate the need to continue CRC screenings on a basis of risks versus benefits, a consideration of comorbidities and screening history.
While a case-by-case basis leaves room for interpretation and doesn't provide a clear answer for all, it frames life expectancy as a central consideration.