Volume 214 - Issue 3
Bowel cancer screening in older patients: is it time to reconsider?
Author: Donald J Frommer
Med J Aust 2021; 214 (3): 143-143.e1. || doi: 10.5694/mja2.50915
Published online: 15 February 2021
Published online: 15 February 2021
To the Editor: In 1996, two articles showed that bowel cancer screening in subjects aged 45–741 and 45–752 years, recruited in the early 1980s, led to a significant reduction in mortality; since then, the age range in Australia’s screening program remains at 50–74 years.
Between 1981 and 2015–2017, the mean life expectancy at birth for men and women in Australia rose by 9.3 and 6.3 years respectively.3 In 2016–2018, the mean life expectancy at 75 years was 12.3 and 14.3 years for men and women respectively, and even at 80 years, the mean life expectancy was 9.1 and 10.6 years respectively,3 suggesting a reduction in morbidity in the 75–79 years cohort over the 1981–2017 period. In 2015, the estimated bowel cancer incidence and mortality rates for Australians in the 75–79 years range were 28% and 82% higher than in the 70–74 years range.4
In the United States, in adults aged 65 years and older, the prevalence of screening was higher than 80% in nine states.5 In Australia, mean participation in the National Bowel Cancer Screening Program (NBCSP) increased with age cohort6 (Box).
Although there is an increased risk of complications from colonoscopy with increasing age, a prospective observational study compared the risks in the 75–79 with the 70–74 years range and found no increase in perforation rates.7
A US study found that colorectal cancer screening was cost‐effective at ages 79 and 80 years even in persons with severe comorbid conditions.8
A recent Australian microsimulation study9 suggested that the cost‐effectiveness of screening the 50–79 and 50–74 year groups would be almost identical, although the advantage of a likely high participation in the 75–79 age range was not addressed. It found that the number of immunochemical faecal occult blood tests and colonoscopies would increase by 10–16% and 21–30% respectively if the screening cessation age were extended to 79 years, both of which should be welcomed. Facilities in Australia can cope with such an increase in colonoscopies.
In view of the above, the NBCSP age range should be extended to 79 years. At a minimum, a pilot study of such an extension should be undertaken.
Box – Australian National Bowel Cancer Screening Program participation
Age (years) |
Participation rates (%) | ||||||||||||||
2014–2015 |
2015–2016 |
2016–2017 |
2017–2018 |
Mean | |||||||||||
50–54 |
28.5 |
28.1 |
29.8 |
31.9 |
29.6 |
||||||||||
55–59 |
36.8 |
35.5 |
35.5 |
37.3 |
36.3 |
||||||||||
60–64 |
43.2 |
42.7 |
43.1 |
43.7 |
43.2 |
||||||||||
65–69 |
43.5 |
44.2 |
47.5 |
49.6 |
46.2 |
||||||||||
70–74 |
52.5 |
52.5 |
52.6 |
53.1 |
52.7 |
||||||||||
Competing interests
No relevant disclosures.
References
- Hardcastle JD, Chamberlain JO, Robinson MH, et al. Randomised controlled trial of faecal‐occult‐blood screening for colorectal cancer. Lancet 1996; 30(348): 1472–1427.
- Kronborg O, Fenger C, Olsen J, et al. Randomised study of screening for colorectal cancer with faecal‐occult‐blood test. Lancet 1996; 30(348): 1467–1471.
- Australian Bureau of Statistics. Australian historical population statistics. 2016 [Cat. No. 3105.0.65.001]. https://www.abs.gov.au/AUSSTATS/abs@.nsf/mf/3105.0.65.001 (viewed Dec 2020).
- Australia Institute of Health and Welfare. Cancer data in Australia [Cat. No. CAN 122]. https://www.aihw.gov.au/reports/cancer/cancer-data-in-australia/data (viewed Dec 2020).
- American Cancer Society. Colorectal cancer facts and figures 2017–2019. https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/colorectal-cancer-facts-and-figures/colorectal-cancer-facts-and-figures-2017-2019.pdf (viewed Dec 2020).
- Australia Institute of Health and Welfare. National cancer screening programs participation data [Cat. No. CAN 114]; updated 2 Dec 2019. https://www.aihw.gov.au/reports/cancer-screening/national-cancer-screening-programs-participation/contents/national-bowel-cancer-screening-program/participation (viewed Dec 2020).
- García‐Albéniz X, Hsu J, Bretthauer M, Hernán MA. Effectiveness of screening colonoscopy to prevent colorectal cancer among medicare beneficiaries aged 70 to 79 years: a prospective observational study. Ann Intern Med 2017; 166: 18–26.
- van Hees F, Habbema JD, Meester RG, et al. Should colorectal cancer screening be considered in elderly persons without previous screening? A cost‐effectiveness analysis. Ann Intern Med 2014; 160(11): 750–759.
- Lew Jie‐Bin, St John D, James B, et al. Benefits, harms, and cost‐effectiveness of potential age extensions to the National Bowel Cancer Screening Program in Australia. Cancer Epidemiol Biomarkers Prev 2018; 27(12): 1450–1461. https://doi.org/10.1158/1055-9965.epi-18-0128.