Colon cancer screening in the elderly: when do we stop?

Colon cancer is a major cause of cancer death in the US. Screening studies can prevent colon cancer and are recommended for average risk persons beginning at 50 years of age. Compliance with these recommendations has increased, particularly among those over 65 years old who have an increased prevalence of cancer and for whom screening is covered by Medicare. However, the efficacy of screening (and surveillance) in this population has not been well studied. The effect of co-morbidities and potentially increased risk of procedures performed on older adults are important concerns. This review addresses the benefits and harms of screening in the elderly. Physician emphasis on health status, life expectancy and patient preferences is critical in decision-making regarding colon cancer screening in this patient population. The recent update in the recommendations of the US Preventive Services Task Force (USPSTF) are reviewed.