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Subsequent colon cancer is rare in older patients with polyps
Clinical Question
What is the rate of development of colorectal cancer in older patients with colon polyps?
Bottom line
In a population of older patients (65 years and older) with colon polyps identified by colonoscopy, few — 0.2% — will develop colon cancer. It may be time to re-evaluate the current recommendations for 5-year surveillance in older patients with previously identified polyps, especially for patients with a calculated shorter life expectancy. (LOE = 1b)
Overuse alert: This POEM aligns with the Canadian Association of General Surgeons’ Choosing Wisely Canada recommendation: Avoid colorectal cancer screening tests in asymptomatic patients with a life expectancy of less than 10 years and with no personal or family history of colorectal neoplasia.
Reference
Study design: Cohort (prospective)
Funding: Government
Setting: Population-based
Synopsis
These investigators used the registry from a single state in the United States to determine the outcome of surveillance colonoscopies performed on 9831 people 65 years or older. Surveillance colonoscopies are performed on individuals with preexisting polyps. The participants were an average of 73.2 years of age, 46.2% were women, and 83.5% were white. Overall, 8% of patients were found to have advanced polyps and 0.2% had colorectal cancer.
Reviewer
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA
Comments
Polyps
What types of Polyps. Did this review look at the type and number ? Many people 65 and older have a life expectancy of over 10 years
2 per 1,000
Stopping cancer screening can be a challenge. This POEM will help my patients to better understand why continuing into advanced age is not recommended for most.
Impact assessment
Excellent
Misinformation
The choosing wisely comment refers to screening , not surveillance . Very different topic
COLON POLYP CONVERTING TO COLON CANCR IN OLDR PATIEN
GOOD TO KNOW
Reduce overuse of screening colonoscopy in older patients
Makes sense to lessen the risk and expense of colonoscopy in patients with life expectancy of less than 10 years.