LSU Journal Club Should Colorectal Cancer Screening be Considered in Elderly Persons without Previous Screening? Claude Pirtle, PGY-I October 16th, 2014 Frank van Hees, MSc; J. Dik F. Habbema, PhD; Reinier G. Meester, MSc; Iris Lansdorp-Vogelaar, PhD; Marjolein van Ballegooijen, MD, PhD*; and Ann G. Zauber, PhD* June 3rd Issue of Annals of Internal Medicine

Objective To determine at what ages CRC screening should be considered in unscreened elderly persons and to determine which test is indicated at each age.

Background The U.S. Preventive Services Task Force recommends against routine screening for colorectal cancer (CRC) in adequately screened persons older than 75 years but does not address the appropriateness of screening in elderly persons without previous screening. 23% of all US persons older than 75 years old. Nearly 10-fold greater risk of cancer than those without previous screening for CRC First study to investigate the net health benefit and the cost- effectiveness.

Study design Microsimulation modeling study MISCAN-Colon – Simulates life histories of a large population from birth to death.

Population Population simulated by MISCAN-Colon – Ages were between 76 and 90 – Simulated patients without previous screening were broken into three groups: no/moderate/severe comorbid conditions – Only persons at average risk for Colorectal cancer

Effectiveness of CRC in unscreened elderly declined with increasing age

The net costs of screening increased substantially with age

Cost-Effectiveness Compared with No Screening

Conclusion Conclusion - In unscreened elderly persons CRC screening should be considered well beyond age 75 years No comorbid conditions, recommended screening – colonoscopy up to age 83 years, sigmoidoscopy at age 84 years, and FIT at ages 85 and 86 years. Moderate comorbid conditions, recommended screening – colonoscopy up to age 80 years, sigmoidoscopy at age 81 years, and FIT at ages 82 and 83 years. Severe comorbid conditions, recommended screening – colonoscopy up to age 77 years, sigmoidoscopy at age 78 years, and FIT at ages 79 and 80 years.

Problems with the study and future research Problem – Did not perform separate analysis by sex and race. Did not perform separate analysis for identifiable high-risk subgroups (family history) Future – Studies evaluating the appropriate age to stop screening by comorbid conditions for adequately screen persons