Abstract
The current recommendation to stop colorectal cancer screening for older adults is based on a lack of evidence due to systematic exclusion of this population from trials. Older adults are a heterogenous population with many available strategies for patient-centered assessment and decision-making. Evolutions in management strategies for colorectal cancer have made safe and effective options available to older adults, and the rationale to screen for treatable disease more reasonably, especially given the aging Canadian population. In this commentary, we review the current screening guidelines and the evidence upon which they were built, the unique considerations for screening older adults, new treatment options, the risks and benefits of increased screening and potential considerations for the new guidelines.
Highlights
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Considerable efforts have focused on tailoring treatment approaches for older adults with colorectal cancer by considering the heterogeneity of health statuses in older adults highlighted by the concepts of physiologic age and frailty [7,8,9,10,11]
Most trials investigating colorectal cancer screening have systematically excluded older adults. We discuss how these unique considerations for older adults should be reflected in updated screening guidelines for colorectal cancer
Summary
Current screening guidelines are based on the absence of a demonstrated benefit in adults aged 75 and older [2]. This absence is not due to a conclusive demonstration that screening lacks benefit in this age group, but rather represents a gap in knowledge due to systematic exclusion of older adults from available studies on which screening recommendations are based (Table 1). Despite the paucity of evidence available to make recommendations due to systematic exclusion of older adults from studies investigating colorectal cancer screening strategies, the authors of the current guidelines chose to recommend not screening in the age group. Other guideline groups have given conditional recommendations to individualize screening decisions but provide little advice on how this should be carried out [18,19,20,21]
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