Colonoscopy for Colorectal Cancer Screening Above Age 75: Outcomes in Symptomatic African American and Hispanic Adults

Abstract

US Preventive Services Task Force recommends against routine screening for colorectal cancer (CRC) in adults above 75years of age. Considerations to support screening in an individual patient are not clearly described. There is limited data to support recommendations in African American (AA) and Hispanics population. We reviewed records of 568 inpatient colonoscopies carried out at our Mt. Sinai Hospital Medical Center, Chicago during 2006-2008 for symptomatic adults ≥75years of age. Subjects with previous normal screening colonoscopies and presence of one or more "generally indicated" indications as per American Society for Gastrointestinal Endoscopy guidelines were included in the study. A total of 155 adults (mean age, 81.8years; 29% males and 71% females; 83.8% AAs and 16.1% Hispanics) met the inclusion criteria. Seventy-nine percent had one previous colonoscopy, whereas 21% of the patients had two or more previous colonoscopies. Common indications for a repeat colonoscopy were anemia 69.7%, hematochezia 39.4%, and fecal occult blood 19.4%. Colonoscopy was completed to the cecum in 65.2% of the subjects. Advanced adenomas/cancers were found in 15/155 (9.7%) colonoscopies. CRC detection rate was 14/155 (9%), of which 9/14 (75%) were staged III/IV. Two (1.3%) patients had complications which resolved conservatively. Symptomatic AAs and Hispanics ≥75 have a high incidence of CRC despite a previous normal colonoscopy. Presence of male sex, new onset anemia and hematochezia, and longer colonoscopy intervals are associated with CRC detection on colonoscopy. The detection of advanced cancer and high comorbidity/low life expectancy limit the benefit of CRC detection.