Udaikumar Jahnavi, Nimmagadda Rithish, Ingawale Sushrut, Lella Vindhya Vasini, Vijayakumar Keerthika, Faye Adam S, Shaukat Aasma
Department of Medicine, NYU Grossman School of Medicine, New York, USA.
Department of Medicine, One Brooklyn Health, New York, USA.
Curr Gastroenterol Rep. 2025 Jun 2;27(1):34. doi: 10.1007/s11894-025-00985-5.
Colorectal cancer (CRC) is a leading cause of cancer-related mortality, with 44% of deaths occurring in individuals aged 75 years and older. With 78 million adults over 65 years projected by 2035, optimizing CRC screening and surveillance is crucial. This review examines guidelines, risks, and personalized approaches.
CRC screening reduces incidence by 17-33% and mortality by 11-53%. Colonoscopy lowers mortality by 61% but has a 6.8% complication rate in those aged 75 years and older. The risk of gastrointestinal bleeding is 8.7 per 1,000 for polypectomy, and perforation occurs in 0.6 per 1,000. Frailty indices assess suitability, but surveillance guidelines lack clear discontinuation criteria. Screening should balance risk, complications, and health status. It may be cost-effective up to age 86 years in healthy individuals, but more research is needed to refine surveillance strategies and reduce overtreatment in older adults.
结直肠癌（CRC）是癌症相关死亡的主要原因，44%的死亡发生在75岁及以上的人群中。预计到2035年，65岁以上的成年人将达到7800万，因此优化CRC筛查和监测至关重要。本综述探讨了相关指南、风险和个性化方法。
CRC筛查可使发病率降低17%-33%，死亡率降低11%-53%。结肠镜检查可使死亡率降低61%，但在75岁及以上人群中的并发症发生率为6.8%。息肉切除术导致胃肠道出血的风险为每1000人中有8.7例，穿孔发生率为每1000人中有0.6例。衰弱指数可评估适用性，但监测指南缺乏明确的终止标准。筛查应权衡风险、并发症和健康状况。对于健康个体，筛查在86岁之前可能具有成本效益，但需要更多研究来完善监测策略并减少对老年人的过度治疗。
