When Do You Stop Screening for Colorectal Cancer?
Colorectal cancer (CRC) is the third most common cancer in terms of incidence and mortality in both males and females in the U.S. Screening remains the best method to detect the disease early and can reduce the incidence of advanced cancers. Depending on which guidance is followed, average-risk adults should start screening at 45 or 50 years, However, there is limited information on the ideal age to stop CRC screening.
The US Preventive Services Task Forces (USPSTF) recommends CRC screening is beneficial only until age 75. In their study published in Clinical Gastroenterology and Hepatology, Cenin et al discuss the age at which men and women should stop screening based on their comorbidities and prior screening results. The authors used a CRC microstimulation model known as Microsimulation Screening Analysis (MISCAN)-colon, which works by answering questions in relation to an individual’s screening and age. The model assesses individuals based on an approach of benefit versus risk using a 76-year-old individual with an exemplary prior screening history as a measure by which all other cases are compared. But, the MISCAN model did not take into account an individual’s prior adherence to screening.
Comparatively, Lansdorp-Vogelaar et al determined that colorectal cancer (CRC) screening with the fecal immunochemical testing (FIT) was reasonable up until 76 years of age, but only up to 66 years of age in individuals who had underlying comorbidities. Furthermore, Tian et al have emphasized the importance of the family history of CRC, primarily because it contributes towards CRC risk and when to stop screening.
Based on the many studies conducted, it has been apparent that prior screening history holds far more importance than the number of underlying comorbidities in individuals. Additionally, the age to stop screening differs drastically between men and women. In women with similar comorbidities as men, screening tests were stopped 12-20 years prior depending on screening history, and as early as 24 years if a colonoscopy was done.
Cenin et al’s study is based on FIT, which is not as relevant in countries where colonoscopy is used as a primary screening test. Individuals who opt for a colonoscopy have longer protection, as opposed to those who opt for FIT. CRC screening can stop at 74 years if the individual had a colonoscopy, irrespective of comorbidities. Therefore, in the U.S., the USPSTF recommends that screening should be stopped at 75 years of age because the primary screening test used is a colonoscopy. According to Pilonis et al, a negative colonoscopy has the ability to provide protection for up to 17.4 years, thereby reducing mortality by 81%.
Cenin et al’s study also emphasizes the importance of attaining a full screening history and past medical history in order to determine what is the best age to stop CRC screening.
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