Colorectal Cancer Screening in the Elderly: The Need for Informed Decision Making

Excerpt

Colorectal cancer screening works! We have convincing evidence from randomized trials of fecal occult blood tests (FOBT) showing that colorectal cancer screening reduces disease-specific morbidity and mortality1. Case-control studies suggest that endoscopy is also effective2‐4. Nonetheless, only about 60% of eligible adults are currently screened for colorectal cancer5. In contrast, nearly 75% of women are currently screened for breast cancer6, which has a similar level of evidence for efficacy as colorectal screening. More than 70% of men are currently screened for prostate cancer, which has uncertain efficacy7. The discordance between evidence and uptake of colorectal cancer screening has sparked considerable efforts to increase screening rates. However, the report by Kahi and colleagues suggests that these efforts may have the unintended consequence of promoting screening recommendations that fail to adequately consider the risks and benefits of screening in the context of a patient′s health status and life expectancy8. …