Colonoscopy In Old Age: What Best to Measure?

A paper looked at the utility of having patients 75+ years old have colonoscopies, which goes against current recommendations.

Among patients 76-85 years old in the United States, colonoscopy use was associated with decreased risks of both distal and proximal CRC, with a smaller risk reduction in distal colon. Due to inherent limitations associated with our retrospective design, future prospective studies are needed to validate these findings.

It is not surprising that a cohort of patients getting colonoscopies - the "gold standard" for colon cancer screening - will exhibit decreased risk for that disease.

But the better measurement would have been - did these patients end up living significantly longer? Did they have better morbidity and mortality? Were there tangible long-term benefits to compensate for the risk (old patients have a higher risk of side effects from colonoscopy that those in the 50-70 age range), cost, and inconvenience of the procedure at such an advanced age?

The recommendations against colonoscopy for age 75+ is not because folks think there is no disease risk at that age, it is because the thought is that these patients will most likely die of other causes and that the cost:benefit ratio for this class of patients is skewed in the direction of greater cost and less benefit.