When are you too old for a colonoscopy? For years, the recommendation of the American Gastroenterological Association (AGA) and the American Cancer Society (ACS) for colorectal cancer (CRC) screening was to have a colonoscopy every ten years beginning at age 45 until age 75. Above age 75, colonoscopy was not recommended. Then, life expectancy of the elderly began to increase, and the quality of life of those folks improved so a reassessment was needed.
Last November, 2023, the AGA issued an updated screening recommendation focused on adults over 75. It stated that screening should be “stratified” meaning the decision to have a colonoscopy was based on “risks, benefits, comorbidities, and screening history.” So, if you’re age 75-85, it was no longer a blanket “No-one-needs-a-colonoscopy” policy. Now, those people determined to have a longer life expectancy, with no comorbidities, could benefit from a colonoscopy until age 80 for men and 90 for women.
For patients who have had a polypectomy, continued colonoscopy is recommended as long as the patient has no comordities that increase the risk of problems from the procedure. A study found that “detecting CRC at surveillance colonoscopy was rare among older adults…. colonoscopies performed among….[for] individuals aged 70-85 with prior polyps, only 0.3% had CRC, and 12% had advanced neoplasia (cancer) detected.” Another similar study detected only 0.2% of patients with CRC. Those folks over age 75 with previous polyps had a 0.3% risk of CRC at 5 years, and a 0.8% risk at 10 years. The risk of death from CRC is even less.
“What this means…patients who are 75 and older should think really carefully about whether they want to do surveillance…..Someone who is very healthy and doesn’t have obvious medical problems can look at the risk for developing colon cancer and the risk of dying and make a decision about whether there’s enough concern to go ahead with surveillance….Those with competing health priorities…..should likely concentrate on those instead and feel reassured they’re probably not doing themselves any harm.”
Older patients who the doctor recommends not have a colonoscopy should not perceive the doctor “is giving up on them.” On the contrary. They should be apprised of the statistics and the risks of colonoscopy and decide for themselves if benefit outweighs risks. It’s really an individual decision based on the health status of the patient. I shouldn’t use myself as an example, but at age 80 I have had several recent surgical procedures under general anesthesia without incident, and think I would tolerate a colonoscopy. However, the prep about did me in the last time, and I would be very reluctant to deal with that, again. I have no family history of CRC nor have I had a previous polyp so my risks of CRC are quite low. I’m due to have a colonoscopy at age 82, but think I’ll do fecal occult blood screening instead.
So, when are you too old for colonoscopy? Ask your doctor about risks and work with him to decide if you should have surveillance. Good luck.
Reference: Crist C. How old is too old for a colonoscopy? Medscape Medical News 2024 August 26.
Seated doctors instill satisfaction, trust in patients: Doctors who sit at the patient’s bedside, or near them in the exam room, earn greater patient trust, enjoy better patient satisfaction, and have better doctor-patient communication than those who stand or whose hand remains attached the the door handle. A study done in a hospital showed that if a chair was within 36” of a patient’s bed, the doctor was likely to sit in it 63% of the time. When less accessible, the doctor would sit during only 8% of the encounters. Sitting also increased a patient’s perception of how long the doctor stayed in the hospital room, and improved the communication of test results and proposed plans of care 72% of the time compared to 52% for “non-sitters.” On the other hand, patients did not retain the information imparted any better if the doctor sat or stood.
I agree with this practice. Sitting on rounds helped me think better and faster, made reading through the patient’s chart easier, and made the patient more comfortable. Sitting does add time to your rounding routine, but patients really appreciate the extra attention they are shown. This study reveals a good practice that doctors should employ, but changing a leopards spots is probably easier than getting doctors to change their behavior.
Reference: Perennou G. Seated Doctors Satisfy Patients Medscape Medical News 2024 August 30. https://www.medscape.com/viewarticle/seated-doctors-satisfy-patients.
Today’s Doctors Lured by more than a Paycheck: The days of Dr. So-and-so just hanging out his shingle and establishing a practice are gone. The majority of young doctors opt to be an employee of a group practice or a hospital. And sometimes, doctors employed by one entity decide to relocate to a different entity for a better opportunity. A paycheck is the main factor in a doctor’s decision to take a job, but employers often “sweeten the pot” to lure highly sought-after doctors away from their current position. These perks are a signing bonus, a monetary allowance for continuing medical education (CME), relocation assistance and housing allowance, and/or educational loan repayment. These financial perks are sometimes complimented by the guarantee of a shorter work week or fewer hours. Any way, employers in need will go to great lengths to hire someone they highly desire. This type of situation is not true for all physician employment, and probably only applies to well-respected clinicians and researchers, but young doctors new in practice are offered signing bonuses often. Today is a different era.
Reference: Coffey D. Beyond the Paycheck: Top Non-salary Perks for Doctors. Medscape Medical News 2024 August 30. https://www.medscape.com/viewarticle/beyond-paycheck-top-nonsalary-perks-for-doctors.
Aspirin May Protect the Unhealthy from Colorectal Cancer: Unhealthy individuals are folks who smoke, drink too much, are obese (high body mass index), and don’t exercise. Correspondingly, these lifestyle issues lead to greater risk for colorectal cancer (CRC). Researchers learned that those taking 2 or more 325mg aspirin per week had a lower 10-year cumulative incidence of CRC. Aspirin-takers had a 1.98% CRC 10- year risk while non-aspirin takers had a 2.95% chance. Is this coincidence? Who knows, but those patients with “healthy lifestyles” had a .11% 10-year incidence. Taking aspirin helped patients who smoked and had a high BMI the most.
Reference: Brooks M. Aspirin for CRC prevention may work best in adults with unhealthy lifestyles. Medscape Medical News 2024 August 27. https://www.medscape.com/viewarticle/aspirin-crc-prevention-may-work/
