Subscribe to RSS
Risk Factors Associated with Colorectal Cancer in Octogenarians Can Help Stratify the Need for Colonoscopy
Objective Colonoscopy is increasingly performed in octogenarians for the detection of colorectal cancer (CRC), but its benefits may be outweighed by its risks. The aim of the present study was to identify the risk factors for CRC in octogenarians presenting for colonoscopy to help stratify the need for this procedure.
Methods A retrospective analysis of 434 patients aged ≥ 80 years referred for a colonoscopy between January 2018 and December 2019. Comparisons were made between those with and without CRC and advanced adenoma (AA). The primary endpoint was to identify the clinical variables predictive of CRC and AA, and the secondary endpoints were complications and death 30 days after the procedure.
Results Colonoscopy was performed in 434 octogenarians, predominantly for symptoms, with CRC in 65 (15.0%) patients. Iron deficiency was associated with a higher risk of having CRC identified on colonoscopy (odds ratio [OR]: 2.33; 95% confidence interval [95%CI] = 1.36–4.00), but not symptoms such as bleeding, weight loss, or diarrhea. A colonoscopy in the last 10 years was protective, with a lower risk of CRC (OR: 0.45; 95%CI = 0.22–0.93). Patients with both normal iron stores and a colonoscopy within 10 years had a 92.5% chance of not having CRC. No variables were predictive of AA. Patients with complications, including death, were older and more likely to have underlying cardiorespiratory disease.
Conclusion Iron status and colonoscopy within 10 years can be used to predict the risk of CRC in octogenarians. Those with low predicted risk, especially if older and with cardiorespiratory disease, should be considered for non-invasive tests, such as computed tomography (CT) colonography, over colonoscopy.
This research did not receive any specific grants from funding agencies in the public, commercial, or not-for-profit sectors.
Received: 07 September 2021
Accepted: 25 October 2021
Article published online:
31 January 2022
© 2022. Sociedade Brasileira de Coloproctologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil
- 1 Ferlay J, Ervik M, Lam F. et al. Global Cancer Observatory: Cancer Today. Lyon, France: International Agency for Research on Cancer; Accessed February 2021 from: https://gco.iarc.fr/today
- 2 Lukens FJ, Loeb DS, Machicao VI, Achem SR, Picco MF. Colonoscopy in octogenarians: a prospective outpatient study. Am J Gastroenterol 2002; 97 (07) 1722-1725
- 3 Stevens T, Burke CA. Colonoscopy screening in the elderly: when to stop?. Am J Gastroenterol 2003; 98 (08) 1881-1885
- 4 Arora A, Singh P. Colonoscopy in patients 80 years of age and older is safe, with high success rate and diagnostic yield. Gastrointest Endosc 2004; 60 (03) 408-413
- 5 Wilson JA. Colon cancer screening in the elderly: when do we stop?. Trans Am Clin Climatol Assoc 2010; 121: 94-103
- 6 Kahi CJ, Azzouz F, Juliar BE, Imperiale TF. Survival of elderly persons undergoing colonoscopy: implications for colorectal cancer screening and surveillance. Gastrointest Endosc 2007; 66 (03) 544-550
- 7 Day LW, Kwon A, Inadomi JM, Walter LC, Somsouk M. Adverse events in older patients undergoing colonoscopy: a systematic review and meta-analysis. Gastrointest Endosc 2011; 74 (04) 885-896
- 8 Costa-Moreira P, Silva M. Screening Colonoscopy in Older Patients: Elder Care or Elder Abuse?. Dig Dis Sci 2020; 65 (07) 1874-1876
- 9 Grossberg LB, Papamichael K, Leffler DA, Sawhney MS, Feuerstein JD. Patients over Age 75 Are at Increased Risk of Emergency Department Visit and Hospitalization Following Colonoscopy. Dig Dis Sci 2020; 65 (07) 1964-1970
- 10 Tran AH, Man Ngor EW, Wu BU. Surveillance colonoscopy in elderly patients: a retrospective cohort study. JAMA Intern Med 2014; 174 (10) 1675-1682
- 11 Cha JM, Kozarek RA, La Selva D. et al. Risks and benefits of colonoscopy in patients 90 years or older, compared with younger patients. Clin Gastroenterol Hepatol 2016; 14 (01) 80-6.e1
- 12 Lin OS. Performing colonoscopy in elderly and very elderly patients: Risks, costs and benefits. World J Gastrointest Endosc 2014; 6 (06) 220-226
- 13 Travis AC, Pievsky D, Saltzman JR. Endoscopy in the elderly. Am J Gastroenterol 2012; 107 (10) 1495-1501 , quiz 1494, 1502
- 14 Maratt JK, Calderwood AH. Colorectal cancer screening and surveillance colonoscopy in older adults. Curr Treat Options Gastroenterol 2019; 17 (02) 292-302
- 15 Kim DH, Pickhardt PJ, Taylor AJ. et al. CT colonography versus colonoscopy for the detection of advanced neoplasia. N Engl J Med 2007; 357 (14) 1403-1412
- 16 Virk GS, Jafri M, Ashley C. Colonoscopy and colorectal cancer rates among octogenarians and nonagenarians: nationwide study of US veterans. Clin Interv Aging 2019; 14: 609-614
- 17 Karajeh MA, Sanders DS, Hurlstone DP. Colonoscopy in elderly people is a safe procedure with a high diagnostic yield: a prospective comparative study of 2000 patients. Endoscopy 2006; 38 (03) 226-230
- 18 Loffeld RJ, Liberov B, Dekkers PE. Yearly diagnostic yield of colonoscopy in patients age 80 years or older, with a special interest in colorectal cancer. Geriatr Gerontol Int 2012; 12 (02) 298-303
- 19 Ioannou GN, Rockey DC, Bryson CL, Weiss NS. Iron deficiency and gastrointestinal malignancy: a population-based cohort study. Am J Med 2002; 113 (04) 276-280
- 20 Lorenzo D, Gallois C, Lahmek P. et al; Groupe des Hémorragies Digestives Basses de l'ANGH (Association Nationale des Hépato-Gastroentérologues des Hôpitaux Généraux). Middle-term mortality and re-bleeding after initial diverticular bleeding: A nationwide study of 365 mostly elderly French patients. United European Gastroenterol J 2017; 5 (01) 119-127
- 21 Singh H, Turner D, Xue L, Targownik LE, Bernstein CN. Risk of developing colorectal cancer following a negative colonoscopy examination: evidence for a 10-year interval between colonoscopies. JAMA 2006; 295 (20) 2366-2373
- 22 Causada-Calo N, Bishay K, Albashir S, Al Mazroui A, Armstrong D. Association Between Age and Complications After Outpatient Colonoscopy. JAMA Netw Open 2020; 3 (06) e208958
- 23 Clarke GA, Jacobson BC, Hammett RJ, Carr-Locke DL. The indications, utilization and safety of gastrointestinal endoscopy in an extremely elderly patient cohort. Endoscopy 2001; 33 (07) 580-584