Prostate and Colon Screenings for Ages 75+

Unfortunately, because many people are scared by the prospect of getting a colonoscopy, more than half of Americans today have not had the procedure.

In August of this year, the U.S. Preventive Services Task Force (USPSTF), a government-appointed panel of medical experts, said they were moderately certain that, for men aged 75 years or older, the potential harms of screening for prostate cancer with a PSA test outweigh the benefits. This conclusion was based on their review of available evidence, which showed small or no benefits of detecting prostate cancer in these older men.

Now, in a recent article in Annals of Internal Medicine, the USPSTF has made a similar recommendation about colonoscopy, another common screening test. The USPSTF now recommends that most people who are 75 or older should not be screened for colon cancer by colonoscopy.

Discontinuing colonoscopies after age 75 is particularly applicable for those who have had normal findings on previous procedures. However, those patients who have a medical history of colon cancer, or suspicious findings on a previous colonoscopy, or a strong family history of colon cancer, may still be asked by their doctors to get a colonoscopy after turning 75, especially if they've never had this procedure done before. The task force, however, stated emphatically that routine colonoscopies were not necessary for anyone over age 85.

Why this hesitancy to give colonoscopy to elderly patients? Simply put, the USPSTF said that the benefits of detecting and treating colon cancer diminish after age 75, whereas the risks of colonoscopy complications — such as a perforated colon, an infection, or an adverse reaction to sedatives — increase in this age group.

These risks were brought home to me recently by what happened to a friend of my wife, a woman in her late 70s. She reluctantly had a colonoscopy, and the procedure was complicated by perforation of the colon, which in turn required a surgical procedure and a hospital stay. In fact, she continues to complain of abdominal pain almost a year later.

My description of this uncommon complication, however, should not deter younger people from having a colonoscopy done every 10 years. Nearly 50,000 Americans are predicted to die this year of colon cancer, the second leading cause of cancer death in this country. Colonoscopy can detect the earliest stages of cancer, which of course is the time when treatment is most likely to lead to a complete cure.

Unfortunately, because many people are scared by the prospect of getting a colonoscopy, more than half of Americans today have not had the procedure. For these reluctant persons, the task force does recommend two — less satisfactory — alternatives to colonoscopy:

  • sigmoidoscopy of the lower colon every 5 years, combined with a stool-blood test every 3 years, or
  • a stool-blood test every year

Some experts were disappointed that the USPSTF recommended sigmoidoscopy for people too fearful to undergo colonoscopy, since this procedure can only inspect the first third of the colon and so cannot detect polyps or cancers located deep within the colon. Instead of a sigmoidoscopy, these critics favor 2 noninvasive tests championed by the American Cancer Society:

  • "virtual colonoscopy," or colonography, carried out with a computed tomography (CT) scan
  • a stool DNA test

The USPSTF, however, did not recommend the CT scan procedure for 2 reasons. First, the task force was concerned about the amount of radiation a patient would receive if a CT scan were done every 5 years. Second, the USPSTF worried that the CT scan might pick up small "blips," which, although harmless, look suspicious and could result in further expensive tests. As for the stool DNA test, a member of the task force said that this exam "has potential but it's [still] an evolving technology," and also that this test is likely to be extremely costly.

Whatever your age, you need to discuss with your doctor the options available to you for the early detection of colon cancer.

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