Task force advises stopping colonoscopies for elderly
December 2nd, 2009 by Jennifer Walker-Journey
The U.S. Preventive Services Task Force, a government-appointed, independent panel of doctors and scientists, raised quite a ruckus with its recommendations on the frequency of mammograms and pap smears, bucking the American Cancer Society’s recommendations by suggesting that fewer screenings were necessary for otherwise healthy women. But the task force’s opinions on colonoscopies mirror those of ACS with at least one small exception – limiting colorectal exams for patients 75 years and older.
ACS and the task force recommend colon screenings beginning at age 50 with one of three tests – colonoscopy every 10 years, a sigmoidoscopy every five years, and a stool blood test annually. ACS also recommends a CT colonography or “virtual colonscopy” and a barium enema every five years. But the Preventive Services Task Force recommends stopping the regular screenings at age 75 unless advised by a physician. It also recommends against screenings for adults older than 85, as “there is moderate certainty that the benefits of screening do not outweigh the harm.” ACS has no recommendations on an upper age limit for colorectal screenings.
Cancer screenings are recommended based on their potential for saving lives by detecting disease early. However, such tests can be physically and emotionally trying, especially for the elderly, which leaves physicians and patients weighing the risks of the screenings against the benefits.
Not only do colonoscopies carry a higher risk of complications such as colon perforation among the elderly, the bowel preparation can also be uncomfortable and sometimes dangerous for older patients. For example, the Food and Drug Administration (FDA) issued a black box warning on oral sodium phosphates, or OSPs, a type of laxative used to clear the bowel before procedures such as colonoscopies, after numerous patients developed a serious kidney injury following use of OSPs. The solutions are no longer recommended for use among older patients as they were more likely to develop the condition than younger patients.
The recommendations are primarily for people who do not have a family history of colorectal cancer. Every patient’s situation is unique, and both ACS and the task force suggest patients discuss their options with their physicians.
Sources:
American Medical News
Associated Press