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Review
. 2022 Jun 15;14(6):1086-1102.
doi: 10.4251/wjgo.v14.i6.1086.

Practical considerations for colorectal cancer screening in older adults

Dana Gornick  1 , Anusri Kadakuntla  1 , Alexa Trovato  1 , Rebecca Stetzer  2 , Micheal Tadros  3
Affiliations
Review

Practical considerations for colorectal cancer screening in older adults

Dana Gornick et al. World J Gastrointest Oncol. .

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: Aged; Cancer screening; Colonoscopy; Colorectal cancer; Early detection of cancer; Elderly.

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Conflict of interest statement

Conflict-of-interest statement: The authors disclose no conflicts of interest or external funding for this publication.

Figures

Figure 1
Figure 1
Practical considerations for colorectal cancer screening in older adults.
Figure 2
Figure 2
Personalized approach to colorectal cancer screening in an older patient. Adapted from Ref. [18,19]. CCI: Charlson comorbidity index; CFS: Clinical frailty scale; PCP: Primary care provider.
Figure 3
Figure 3
Applying and interpreting the clinical frailty score. Citation: Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I, Mitnitski A. A global clinical measure of fitness and frailty in elderly people. CMAJ 2005; 173: 489-495. Copyright © CMA Impact Inc.
Figure 4
Figure 4
Steps in the evaluation of decisional capacity. 1Include patient in process.
See this image and copyright information in PMC

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