Colorectal Cancer Screening in the Older Adult: A Case-Based Approach

  • Brijen J. Shah
  • Sita Chokhavatia


This chapter uses a case-based approach to discuss special considerations for colon cancer screening in the geriatric population. Based on current guidelines and prevalence of colon cancer, a framework is provided on decisions to screen, risks and benefits of screening, as well as complications from screening in the older adult. A brief discussion follows on emerging technologies with regards to colon cancer screening.


Fecal Occult Blood Test Compute Tomographic Colonography Flexible Sigmoidoscopy Geriatric Population Colon Cancer Screening 
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  1. 1.
    US Preventive Services Task Force (USPSTF). Screening for colorectal cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2008;149(9):627–37.Google Scholar
  2. 2.
    Leipzig RM, Whitlock EP, Wolff TA, et al., US Preventive Services Task Force Geriatric Workgroup. Reconsidering the approach to prevention recommendations for older adults. Ann Intern Med. 2010;153(12):809–14.Google Scholar
  3. 3.
    Kaiser Permanente Care Management Institute. Colorectal cancer screening clinical practice guideline. Oakland: Kaiser Permanente Care Management Institute; 2008. p. 190.Google Scholar
  4. 4.
    World Gastroenterology Organisation (WGO). Practice guidelines: colorectal cancer screening. Paris: World Gastroenterology Organisation (WGO); 2007.Google Scholar
  5. 5.
    Davila RE, Rajan E, Baron TH, et al., Standards of Practice Committee, American Society for Gastrointestinal Endoscopy. ASGE guideline: colorectal cancer screening and surveillance. Gastrointest Endosc. 2006;63(4):546–57.CrossRefGoogle Scholar
  6. 6.
    Ko C, Hyman NH, Standards Committee of The American Society of Colon and Rectal Surgeons. Practice parameter for the detection of colorectal neoplasms: an interim report (revised). Dis Colon Rectum. 2006;49(3):299–301.PubMedCrossRefGoogle Scholar
  7. 7.
    Winawer SJ, Zauber AG, Fletcher RH, et al. Guidelines for colonoscopy surveillance after polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer and the American Cancer Society. CA Cancer J Clin. 2006;56(3):143–59.PubMedCrossRefGoogle Scholar
  8. 8.
    Taylor BA, Ramakrishnan S, Gopal K. The NHS bowel cancer screening programme. Colorectal Dis. 2009;11(3):327–8.PubMedCrossRefGoogle Scholar
  9. 9.
    Levin B, Lieberman DA, McFarland B, et al., American Cancer Society/US Multi-Society Task Force on Colorectal Cancer/American College of Radiology (ACS/USMSTF/ACR). Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. CA Cancer J Clin. 2008;58(3):130–60.Google Scholar
  10. 10.
    Rex D, Johnson D, Anderson J, et al. American college of gastroenterology guidelines for colorectal cancer screening 2008. Am J Gastroenterol. 2009;104:739–50.PubMedCrossRefGoogle Scholar
  11. 11.
    Winawer S, Fletcher R, Rex D, et al. AGA Colorectal Cancer screening and surveillance: clinical guidelines and rationale—update based on new evidence. Gastroenterology. 2003;124:544–60.PubMedCrossRefGoogle Scholar
  12. 12.
    Howlader N, Noone AM, Krapcho M, et al., editors. SEER cancer statistics review, 1975–2008. Bethesda: National Cancer Institute; 2011., based on November 2010 SEER data submission, posted to the SEER web site.
  13. 13.
    Wilson JA. Colon cancer screening in the elderly: when do we stop? Trans Am Clin Climatol Assoc. 2010;121:94–103.PubMedGoogle Scholar
  14. 14.
    Rozen P, Liphshitz I, Barchana M. The changing epidemiology of colorectal cancer and its relevance for adapting screening guidelines and methods. Eur J Cancer Prev. 2011;20(1):46–53.PubMedCrossRefGoogle Scholar
  15. 15.
    Kwok A, Faigel D. Management of anticoagulation before and after gastrointestinal endoscopy. Am J Gastroenterol. 2009;104:3085–97.PubMedCrossRefGoogle Scholar
  16. 16.
    Walter LC, Covinsky KE. Cancer screening in elderly patients: a framework for individualized decision making. JAMA. 2001;285(21):2750–6.PubMedCrossRefGoogle Scholar
  17. 17.
    Levi Z, Rozen P, Hazazi R, et al. Sensitivity, but not specificity, of a quantitative immunochemical fecal occult blood test for neoplasia is slightly increased by the use of low-dose aspirin, NSAIDs, and anticoagulants. Am J Gastroenterol. 2009;104(4):933–8.PubMedCrossRefGoogle Scholar
  18. 18.
    Rosman AS, Korsten MA. Effect of verification bias on the sensitivity of fecal occult blood testing: a meta-analysis. J Gen Intern Med. 2010;25(11):1211–21.PubMedCrossRefGoogle Scholar
  19. 19.
    Kahi CJ, Rex DK, Imperial TF. Screening, surveillance, and primary prevention for colon cancer: a review of the recent literature. Gastroenterology. 2008;135:380–99.PubMedCrossRefGoogle Scholar
  20. 20.
    Hundt S, Haug U, Brenner H. Comparative evaluation of immunochemical fecal occult blood tests for colorectal adenoma detection. Ann Intern Med. 2009;150:162–9.PubMedGoogle Scholar
  21. 21.
    Brenner H, Tao S, Haug U. Low-dose aspirin use and performance of immunochemical fecal occult blood tests. JAMA. 2010;304:2513–20.PubMedCrossRefGoogle Scholar
  22. 22.
    Rozen P, Shabtai EI, Liphshitz I, Barchana M. Risk for colorectal cancer in elderly persons and possible methodologies for their screening. Eur J Gastroenterol Hepatol. 2011;23(5):431–7.PubMedCrossRefGoogle Scholar
  23. 23.
    Imperiale TF, Ransohoff DF, Itzkowitz SH, et al. Fecal DNA versus fecal occult blood for colorectal-cancer screening in an average-risk population. NEJM. 2004;351:2704–14.PubMedCrossRefGoogle Scholar
  24. 24.
    Habermann JK, Roblick UJ, Luke BT, et al. Increased serum levels of complement C3a anaphylatoxin indicate the presence of colorectal tumors. Gastroenterology. 2006;131:1020–9.PubMedCrossRefGoogle Scholar
  25. 25.
    Leman ES, Schoen RE, Weissfeld JL, et al. Initial analyses of colon cancer-specific antigen (CCSA)-3 and CCSA-4 as colorectal cancer associated serum markers. Cancer Res. 2007;67:5600–5.PubMedCrossRefGoogle Scholar
  26. 26.
    Ko CW, Sonnenberg A. Comparing risks and benefits of colorectal cancer screening in elderly patients. Gastroenterology. 2005;129(4):1163–70.PubMedCrossRefGoogle Scholar
  27. 27.
    Day LW, Inadmoi JM, Somsouk M. Adverse events in elderly patients undergoing colonoscopy: a meta-analysis. Gastroenterology. 2010;138(5 Suppl 1):S-126.CrossRefGoogle Scholar
  28. 28.
    Lebwohl B, Wang TC, Neugut AI. Socioeconomic and other predictors of colonoscopy preparation quality. Dig Dis Sci. 2010;55(7):2014–20.PubMedCrossRefGoogle Scholar
  29. 29.
    Chung YW, Han DS, Park KH, et al. Patient factors predictive of inadequate bowel preparation using polyethylene glycol: a prospective study in Korea. J Clin Gastroenterol. 2009;43(5):448–52.PubMedCrossRefGoogle Scholar
  30. 30.
    Singhal S, Basi P, Mathur S, et al. Outcome analysis of colonoscopy in elderly African American, Hispanic and Asian Americans above age 85. Gastroenterology. 2010;138(5 Suppl 1):S-126.CrossRefGoogle Scholar
  31. 31.
    Neerincx M, Terhaar sive Droste JS, Mulder CJ, et al. Colonic work-up after incomplete colonoscopy: significant new findings during follow-up. Endoscopy. 2010;42(9):730–5.PubMedCrossRefGoogle Scholar
  32. 32.
    Schmilovitz-Weiss H, Weiss A, Boaz M, et al. Predictors of failed colonoscopy in nonagenarians: a single-center experience. J Clin Gastroenterol. 2007;41(4):388–93.PubMedCrossRefGoogle Scholar
  33. 33.
    Reguerio CR. AGA Future Trends Committee Report: colorectal cancer: a qualitative review of emerging screening and diagnostic technologies. Gastroenterology. 2005;129:1082–103.Google Scholar
  34. 34.
    Seinela L, Pehkonen E, Laasanen T, et al. Bowel preparation for colonoscopy in very old patients. A randomized prospective trial comparing oral sodium phosphate and polyethylene glycol electrolyte lavage solution. Scand J Gastroenterol. 2003;38:216–20.PubMedCrossRefGoogle Scholar
  35. 35.
    Cohen L. Split dosing of bowel preparations for colonoscopy: an analysis of its efficacy, safety, and tolerability. Gastrointest Endosc. 2010;72:406–12.PubMedCrossRefGoogle Scholar
  36. 36.
    Belsey J, Epstein O, Heresbach D. Systematic review: adverse event reports for oral sodium phosphate and polyethylene glycol. Aliment Pharmacol Ther. 2008;29:15–28.PubMedCrossRefGoogle Scholar
  37. 37.
    Sieg A, Friedrich K, Sieg U. Is PillCam COLON capsule endoscopy ready for colorectal cancer screening? A prospective feasibility study in a community gastroenterology practice. Am J Gastroenterol. 2009;104:848–54.PubMedCrossRefGoogle Scholar
  38. 38.
    Gay G, Delvaux M, Frederic M, et al. Could the colonic capsule PillCam Colon be clinically useful for selecting patients who deserve a complete colonoscopy?: results of clinical comparison with colonoscopy in the perspective of colorectal cancer screening. Am J Gastroenterol. 2010;105:1076–86.PubMedCrossRefGoogle Scholar
  39. 39.
    Spada C, Hassan C, Munoz-Navas M, et al. Second-generation colon capsule endoscopy compared with colonoscopy. Gastrointest Endosc. 2011;74(3):581–9.e1.PubMedCrossRefGoogle Scholar
  40. 40.
    Fenlon HM, Nunes DP, Schroy PC, et al. A comparison of virtual and conventional colonoscopy for the detection of colorectal polyps. NEJM. 1999;341:1496–503.PubMedCrossRefGoogle Scholar
  41. 41.
    Johnson CD, Chen MH, Toledano AY, et al. Accuracy of CT colonography for detection of large adenomas and cancer. NEJM. 2008;359:1207–17.PubMedCrossRefGoogle Scholar
  42. 42.
    Kim DH, Pickhardt PJ, Hanson ME, et al. CT colonography: performance and program outcome measures in an older screening population. Radiology. 2010;254:493–500.PubMedCrossRefGoogle Scholar
  43. 43.
    Lauenstein T, Holtman G, Schoenfelder D, et al. MR colonography without colonic cleansing: a new strategy to improve patient acceptance. AJR. 2001;177:823–7.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Department of Medicine and The Brookdale Department of Geriatrics, The Henry D. Janowitz Division of GastroenterologyMount Sinai Medical CenterNew YorkUSA
  2. 2.Departments of Internal Medicine and GastroenterologyMount Sinai HospitalNew YorkUSA

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