Should we screen for colorectal cancer in people aged 75 and over? A retrospective analysis of observations from a tertiary care center

Aims The decision to screen for colorectal cancer (CRC) in individuals aged 75 and older is challenging due to limited data on this age group, where screening benefits are less clear and procedural risks increase with age. This study assesses the prevalence of CRC and associated risk factors in elderly patients to help guide screening decisions.

Methods This retrospective study was conducted over two years, from January 2022 to September 2024, in the hepatogastroenterology department of Monastir. A total of 148 patients over 75 years who underwent screening colonoscopy for specific indications were included.

Results The mean age was 80.78 years (range 75–88), with a male predominance (54.1%; sex ratio 1.17). Twelve patients had a history of CRC surgery, 76 had cardiovascular comorbidities (51.4%), and 32 had metabolic disorders (21.6%). Indications for colonoscopy included chronic constipation in 74 patients (50%), abdominal pain in 42 (28.4%), iron deficiency anemia in 26 (17.5%), and general health deterioration in 6 (4.1%). Colonoscopy was incomplete in 24.3% of cases (36 patients) due to poor bowel preparation (18.9%); preparation quality was moderate in 42.56% and good in 38.51% of cases. Findings were normal in 70.27% (104 patients), with abnormalities in 44 patients, including CRC in 13 patients (8.7%), colonic diverticulosis in 17, colorectal polyps in 12, and angiodysplastic lesions in 3. Univariate analysis showed that CRC presence was significantly associated with iron deficiency anemia. Neither age nor sex was significantly associated with CRC.

Conclusions The decision to screen for CRC in patients aged 75 and over should be well-considered and personalized. Our findings, showing a CRC prevalence of only 8.7% in this population, suggest a tailored screening strategy for individuals above 75.

Publication History

Article published online:
27 March 2025