Screening for Colon Cancer in Older Patients: “I’m in Pretty Good Shape for the Shape I’m in”

 Mr. J is 89 and has been diagnosed and treated for colon cancer twice. Both colon cancers were found after age 75.  The first cancer was diagnosed and successfully treated at the age of 79.  The second cancer was discovered in early 2017 at the age of 89.

The National Colon Cancer Screening Guidelines recommends that screening begin at age 50 and end at age 75. Discontinuation after age 75 is recommended because by this age, people have multiple chronic conditions such as heart failure, dementia, limited mobility, and diabetes. In such cases, these patients may not live long enough to benefit from the test.

Additionally, the preparation for the test in the elderly is more challenging.  One must drink four liters of a laxative over six to seven hours. As a result, there is the risk of injury from a fall as he or she tries to repeatedly rush to the bathroom. Finally, there is a higher complication rate from the colonoscopy (major bleeding) or memory issues from the anesthesia in this age group.

In 2016, the colon cancer screening guideline started including recommendations for persons 76 to 85 years of age and states: “The decision to screen for colorectal cancer in adults aged 76 to 85 years should be an individual one, considering the patient’s overall health.”  Again, Mr. J was older than this age group.

Despite this, Mr. J wanted to have another colonoscopy to make sure there was no cancer present. Of note, he did not have any significant chronic conditions and mental faculties were quite good.  Plus, he played golf two times a week.

The colonoscopy revealed another large cancer in his colon. Surgery was performed without any significant complications and his hospital stay lasted only four days.

All in all, National Colon Cancer Screening Guidelines are helpful and are based on scientific research.   Unfortunately, because of his age, they excluded Mr. J.  Shared decision-making and patient preference are invaluable tools because patients still have the right to make decisions about their medical care.

As Mr. J leaves my office seven months after successful surgery, he says, “I’m in pretty good shape for the shape I’m in.” I agreed and added that he is a living miracle. 

His experience helped me to see how far medical science has come in treating cancer, when found at a stage it can be cured, regardless of age.