Risks and benefits of colonoscopy for elderly patients
Dear OncoLink "Ask The Experts,"
I would like information concerning the risk/benefits of colonoscopy for elderly patients (>80 yrs). Does the risk of bowel perforation increase with the patient's age? When do the risks of the complications outweigh the benefits that might be derived? What if the patient is not in a high colon cancer risk group? Are there any less invasive screening procedures that provide similar information?
Timothy Hoops, MD, Clinical Assistant Professor of Medicine in the Gastroenterology Division at the University of Pennsylvania and Director of Gastroenterology at Penn Medicine at Radnor, responds:
You have a lot of difficult questions that don't have a lot of data that would support good answers. The quoted risks for perforation vary from 3/1000 to 1/8000, but 3/10,000 is probably a good number. There is no data to suggest that this risk increases with age, although we often worry that these older patients may be at a higher risk with weaker tissues, other diseases and other problems that could worsen the potential outcome. Should 80 year olds be screened? The reason for screening is to prevent future cancers and to diagnose current ones. The projected life span of an 80-year-old person is obviously less than a person who is 60. However, they are at the highest risk for colon cancer. In general, if they are relatively healthy and could tolerate treatment such surgery if a cancer were found, a screening exam may be worthwhile. You would find many opinions on this, however. The higher the pretest risk, the stronger the case for doing the study.
At this point, the "virtual" colonoscopies, either CT or MRI, are not developed enough that they are easily available to patients. However, in the future, these may be very useful as they are safer and are quite good at detecting cancers and large polyps. If these were found, a true colonoscopy could then be performed if desired.