early detection of cancer

Patients with BRCA mutations should consider prophylactic ovariectomies prior to age 50 based upon this epidemiological simulation. James W. Mold, MD, MPH

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Importance Women with a BRCA1 or BRCA2 variant face a high lifetime risk of ovarian cancer and are often advised to undergo preventive surgery (bilateral salpingo-oophorectomy [BSO]) before cancer develops. The recommended age of BSO is 35 years for BRCA1 carriers and is 45 years for BRCA2 carriers, but some women choose to delay surgery until the age of menopause; there is no standard upper age at which surgery is no longer advised.

Objective To estimate the residual lifetime risk of ovarian cancer among BRCA carriers by current age and projected age at BSO.

Design, Setting, and Participants This was a prospective cohort study in an international cohort of BRCA carriers monitored for incident ovarian cancer. A life table analysis used age-specific ovarian cancer incidence rates and competing mortality rates to estimate lifetime risk of ovarian cancer among women with a BRCA1 or BRCA2 pathogenic variant with both ovaries intact and no prior ovarian cancer at baseline. Patients were recruited between 1995 and 2024 across 24 international centers, and the mean (SD) follow-up was 4.4 (3.9) years.

Exposure Timing of BSO, defined as immediate BSO, delayed BSO, or no BSO.

Main Outcome and Measures Residual lifetime risk of ovarian cancer.

Results The cohort consisted of 4286 BRCA1 and 1427 BRCA2 carriers between the ages of 30 and 74 years at baseline (mean [SD] age, 42.0 [10.8] years). There were 249 incident ovarian cancers in the follow-up period. The lifetime risk of ovarian cancer was 55.0% (95% CI, 48.8-61.9) for a BRCA1 carrier and 24.1% (95% CI, 15.1-36.6) for a BRCA2 carrier. A 30-year-old BRCA1 carrier with BSO delayed to age 50 years had a projected residual ovarian cancer risk of 23.9% (95% CI, 20.7-27.4). At age 75 years, the residual risk of ovarian cancer was estimated to be 8.4% (95% CI, 1.7-22.7) for a BRCA1 carrier and 3.7% (95% CI, 0.1-22.7) for a BRCA2 carrier.

Conclusions and Relevance The residual risk of ovarian cancer for older women in good health is sufficiently high to consider preventive surgery. BRCA1 carriers who defer BSO until age 50 years may face a substantial risk of developing ovarian cancer.

Author/s:

Vasily Giannakeas, PhD, Adriana I. Apostol, MD, Claudia Diella, et al.

Cervical Cancer Screening Updates—Focus on Self-Collected Primary Human Papillomavirus Testing

Mary Cervantes — Fri, 28 Aug 2026 01:36:17 +0000

Date Added:

August 27, 2026

Journal/Publication:

JAMA Internal Medicine: Clinical Insights

Publisher:

JAMA Internal Medicine

Publication Date:

August 24, 2026

URL:

Cervical Cancer Screening Updates—Focus on Self-Collected Primary Human Papillomavirus Testing

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jamainternmed.2026.3980

Keywords

cervical cancer

Cervical Cancer Screening

Papillomavirus Testing

Screening Updates

Women's Health

MeSH

early detection of cancer

Early Detection of Cancer / standards

Early Detection of Cancer* / methods

American Cancer Society

Gynecologists

Papillomavirus Infections

uterine cervical neoplasms

Uterine Cervical Neoplasms* / diagnosis

primary health care

female

An update to the cervical cancer screening guidelines from the USPSTF. James W. Mold, MD, MPH

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The incidence and mortality of cervical cancer have fallen since the adoption of widespread screening, but it still disproportionately affects underserved populations in the US. Expanding access to screening, especially in primary care settings, may reduce these disparities and improve women’s health. This Clinical Insights article summarizes cervical cancer screening recommendations for patients with average and higher than average risk, including recommendations for self-collected human papillomavirus (HPV) testing. It highlights statements by the US National Cancer Institute–sponsored Enduring Guidelines Committee, which was established to continuously evaluate new technologies for cervical cancer screening, management, and surveillance.

Author/s:

Hunter K. Holt, MD, MAS, Yasaswi Kislovskiy, MSc, George F Sawaya

New Cervical Cancer Screening Guidelines From the US Department of Health and Human Services: Strengthening Women’s Preventive Health

Megan George — Tue, 06 Jan 2026 14:29:39 +0000

Date Added:

January 6, 2026

Journal/Publication:

JAMA

Publication Date:

January 5, 2026

URL:

New Cervical Cancer Screening Guidelines From the US Department of Health and Human Services: Strengthening Women’s Preventive Health

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2025.26456

Keywords

cervical cancer

Cancer Screeing

PMID (1):

41489823

MeSH

uterine cervical neoplasms

Papanicolaou Test

early detection of cancer

Uterine Cervical Dysplasia

Human Papillomavirus Viruses

Updated HRSA (2026) guidelines for cervical cancer screening. James W. Mold, MD, MPH

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Cervical cancer screening is one of the most significant public health accomplishments of the 20th century. Over the last 50 years, incidence and mortality rates from cervical cancer in the US have decreased by more than 50%1 because of widespread use of the Papanicolaou test and later adoption of high-risk human papillomavirus (hrHPV) testing.

Regular screening is critical in detecting disease because women with precancerous cervical intraepithelial neoplasia or early-stage cervical cancer are often asymptomatic. When detected early, 5-year cervical cancer survival is higher than 90%.1 Yet more than half of all cervical cancer diagnoses are made beyond an early stage; 37% when cancer has spread regionally to local lymph nodes and 15% when there are distant cancer metastases. Five-year survival is just 20% for women diagnosed with metastatic disease.1

Cervical cytology (Papanicolaou test) and hrHPV tests are highly effective in detecting early, more treatable disease; however, these modalities are only beneficial for women who undergo recommended screening. Unfortunately, about half of all women diagnosed with cervical cancer have never been screened or are not up-to-date on screening,2 and these women are more likely to present with regional or distant metastatic disease. Overall, approximately 1 in 4 women in the US are not up-to-date on cervical cancer screening.3 Women living in poverty or having fewer years of formal education have even lower screening rates. The direct link between screening and survival illustrates a clear and urgent need to improve cervical cancer screening rates in the US; new self-collection options approved by the US Food and Drug Administration (FDA) provide an opportunity to do so.

Author/s:

Brian Christine, Margaret Bush, Anita Thurakal, Ann M Sheehy

What Is Prostate Cancer?

Megan George — Fri, 25 Jul 2025 13:49:16 +0000

Date Added:

July 25, 2025

Journal/Publication:

JAMA Patient Page

Publication Date:

July 24, 2025

URL:

What Is Prostate Cancer?

Type:

Patient Education Materials

DOI (1):

10.1001/jama.2025.10177

Keywords

Patient Information

jama Patient Information

MeSH

Prostate-Specific Antigen

Digital Rectal Examination

early detection of cancer

Early Detection of Cancer* / methods

Information for patients about prostate cancer. James W. Mold, MD, MPH

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Prostate cancer is a common malignancy in older men. Prostate cancer typically affects older men (average age at diagnosis is 67 years) and is more common among Black men than White men.1 More than half of prostate cancer risk is due to genetic factors. Prostate cancer is the second most common cause of cancer in men worldwide, with about 1.5 million cases diagnosed in 2021. In the US, 3.4 million men were living with prostate cancer in 2021.

Author/s:

Rebecca Voelker, MSJ

What Is Lynch Syndrome?

Alex Haga — Fri, 07 Jun 2024 01:17:14 +0000

Date Added:

June 6, 2024

Journal/Publication:

JAMA

Publication Date:

June 1, 2024

URL:

What Is Lynch Syndrome?

Type:

Patient Education Materials

Format:

Article

DOI (1):

10.1001/jama.2024.8552

Keywords

PMID (1):

38823004

MeSH

Colorectal Neoplasms

early detection of cancer

Genetic Counseling

Uterine Neoplasms

Carcinoma

Carcinoma, Squamous Cell

Information for patients about Lynch Syndrome, the most common cause of hereditary colorectal cancer and a number of other cancers. James W. Mold, MD, MPH

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This JAMA Patient Page describes Lynch syndrome, its risk factors and diagnosis, and its association with colorectal cancer and other specific cancers.

Author/s:

Kasey Hornbuckle, Cassandra D L Fritz

Screening for Breast Cancer

Alex Haga — Tue, 07 May 2024 21:10:39 +0000

Date Added:

May 7, 2024

Journal/Publication:

JAMA Patient Page

Publisher:

JAMA

Publication Date:

April 30, 2024

URL:

Screening for Breast Cancer

Type:

Patient Education Materials

Format:

Article

DOI (1):

10.1001/jama.2024.5535

Keywords

Early Detection of Cancer

PMID (1):

38687488

MeSH

breast neoplasms

mammography

early detection of cancer

risk assessment

Information for patients about the new screening recommendations from the USPSTF. James W. Mold, MD, MPH

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We all want better ways to find breast cancer early and save lives from this disease. Breast cancer screening can detect cancer early, when it’s most treatable. This guide is meant to help you and your health care professional understand the benefits and risks of breast cancer screening, including what age to start screening and how often people should be screened. This guide is not for women who have a BRCA gene variant, a history of chest radiation, or a personal history of breast cancer. These women should talk to their health care professional about how best to stay healthy.

Author/s:

US Preventive Services Task Force

Screening for Breast Cancer: US Preventive Services Task Force Recommendation Statement

Alex Haga — Tue, 07 May 2024 21:01:58 +0000

Date Added:

May 7, 2024

Journal/Publication:

JAMA

Publisher:

JAMA

Publication Date:

April 30, 2024

URL:

Screening for Breast Cancer: US Preventive Services Task Force Recommendation Statement

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2024.5534

Keywords

breast cancer

cancer screening

breast neoplasms

Early Detection of Cancer

mammography

PMID (1):

38687503

MeSH

early detection of cancer

Magnetic Resonance Imaging

The USPSTF now recommends beginning biennial breast cancer screening at 40 rather than 50 in most women. James W. Mold, MD, MPH

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Importance: Among all US women, breast cancer is the second most common cancer and the second most common cause of cancer death. In 2023, an estimated 43 170 women died of breast cancer. Non-Hispanic White women have the highest incidence of breast cancer and non-Hispanic Black women have the highest mortality rate.

Objective: The USPSTF commissioned a systematic review to evaluate the comparative effectiveness of different mammography-based breast cancer screening strategies by age to start and stop screening, screening interval, modality, use of supplemental imaging, or personalization of screening for breast cancer on the incidence of and progression to advanced breast cancer, breast cancer morbidity, and breast cancer-specific or all-cause mortality, and collaborative modeling studies to complement the evidence from the review.

Population: Cisgender women and all other persons assigned female at birth aged 40 years or older at average risk of breast cancer.

Evidence assessment: The USPSTF concludes with moderate certainty that biennial screening mammography in women aged 40 to 74 years has a moderate net benefit. The USPSTF concludes that the evidence is insufficient to determine the balance of benefits and harms of screening mammography in women 75 years or older and the balance of benefits and harms of supplemental screening for breast cancer with breast ultrasound or magnetic resonance imaging (MRI), regardless of breast density.

Recommendation: The USPSTF recommends biennial screening mammography for women aged 40 to 74 years. (B recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening mammography in women 75 years or older. (I statement) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of supplemental screening for breast cancer using breast ultrasonography or MRI in women identified to have dense breasts on an otherwise negative screening mammogram. (I statement).

Author/s:

US Preventive Services Task Force

Cervical Cancer Screening

Erin Blanchette — Mon, 13 Nov 2023 16:19:48 +0000

Date Added:

November 14, 2023

Journal/Publication:

JAMA

Publisher:

American Medical Association

Publication Date:

October 27, 2023

URL:

Cervical Cancer Screening

Type:

Patient Education Materials

Format:

Article

DOI (1):

10.1001/jama.2023.21987

Keywords

Human Papillomavirus Viruses

PMID (1):

37889510

MeSH

Human Papillomavirus Viruses

Cervix Uteri

uterine cervical neoplasms

early detection of cancer

Papanicolaou Test

Patient education regarding cervical cancer screening. James W. Mold, MD, MPH

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This JAMA Patient Page discusses screening for cervical cancer, including who should be screened, recommendations for handling positive results, and the prevention of cervical cancer.

Author/s:

Rebecca A. Voelker

American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline

Rowan Hutchins — Sun, 08 Oct 2023 05:00:00 +0000

Date Added:

October 8, 2023

Journal/Publication:

Publisher:

ACS

Publication Date:

December 7, 2015

URL:

American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.3322/caac.21319

Keywords

breast cancer

cancer survivors

Neoplasms

PMID (1):

26641959

MeSH

breast neoplasms

Survivors

early detection of cancer

Genetic Counseling

Guidelines for care of breast cancer survivors developed by the American Cancer Society and the American Society for Clinical Oncology. The Guideline recommendations are listed in Table 3. James W. Mold, MD, MPH

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The purpose of the American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline is to provide recommendations to assist primary care and other clinicians in the care of female adult survivors of breast cancer. A systematic review of the literature was conducted using PubMed through April 2015. A multidisciplinary expert workgroup with expertise in primary care, gynecology, surgical oncology, medical oncology, radiation oncology, and nursing was formed and tasked with drafting the Breast Cancer Survivorship Care Guideline. A total of 1073 articles met inclusion criteria; and, after full text review, 237 were included as the evidence base. Patients should undergo regular surveillance for breast cancer recurrence, including evaluation with a cancer-related history and physical examination, and should be screened for new primary breast cancer. Data do not support performing routine laboratory tests or imaging tests in asymptomatic patients to evaluate for breast cancer recurrence. Primary care clinicians should counsel patients about the importance of maintaining a healthy lifestyle, monitor for post-treatment symptoms that can adversely affect quality of life, and monitor for adherence to endocrine therapy. Recommendations provided in this guideline are based on current evidence in the literature and expert consensus opinion. Most of the evidence is not sufficient to warrant a strong evidence-based recommendation. Recommendations on surveillance for breast cancer recurrence, screening for second primary cancers, assessment and management of physical and psychosocial long-term and late effects of breast cancer and its treatment, health promotion, and care coordination/practice implications are made. CA Cancer J Clin 2016;43–73. © 2015 American Cancer Society.

Author/s:

Carolyn D. Runowicz MD, Corinne R. Leach PhD, MS, MPH, N. Lynn Henry MD, PhD, Karen S. Henry MSN

Lung cancer crash course

Aubrey Delammermore — Sat, 22 Apr 2023 05:00:00 +0000

Date Added:

April 22, 2023

Journal/Publication:

Canadian Family Physician

Publisher:

College of Family Physicians of Canada

Publication Date:

April 1, 2023

Issue:

Volume:

Pages:

266-268

URL:

Lung cancer crash course

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.46747/cfp.6904266

Keywords

liver

brain

Survival Rate

Small Cell Lung Carcinoma

Canada

PMID (1):

37072209

MeSH

Lung Neoplasms*

Carcinoma, Non-Small-Cell Lung

early detection of cancer

Carcinoma, Squamous Cell

A concise review of the diagnosis, classification, and treatment and treatment of lung cancer. James W. Mold, MD, MPH

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Lung cancer has the highest mortality rate of any cancer in Canada, causing 25.5% of all cancer deaths, with a 5-year survival rate of only 19%. More than half of lung cancers are metastatic at diagnosis, with common sites of metastases in the brain, bone, liver, and adrenal glands. Lung cancer is a heterogeneous group of cancers broadly separated into small cell lung cancer (SCLC)—approximately 15% of all lung cancer cases—and non–small cell lung cancer (NSCLC), which is further divided into predominantly adenocarcinoma and squamous cell carcinoma subtypes. More than 80% of lung cancer cases are related to smoking, meaning smoking cessation remains the cornerstone of lung cancer prevention. Low-dose computed tomography is a valuable screening tool for lung cancer that can identify lung cancers at an earlier stage and reduce lung cancer–specific mortality and all-cause mortality. Although lung cancer screening is recommended by the Canadian Task Force on Preventive Health Care, it is currently available in only a few Canadian provinces.

Author/s:

Wilkinson, A. N.

What Should I Know About Stopping Routine Cancer Screening?

Rowan Hutchins — Sun, 19 Mar 2023 05:00:00 +0000

Date Added:

March 19, 2023

Journal/Publication:

JAMA

Publisher:

American Medical Association

Publication Date:

March 13, 2023

URL:

What Should I Know About Stopping Routine Cancer Screening?

Type:

Patient Education Materials

Format:

Article

DOI (1):

10.1001/jamainternmed.2023.0088

Keywords

cancer

cancer screening

Neoplasms

PMID (1):

36912847

MeSH

early detection of cancer

Information for patients on when and why to stop getting screening tests for cancer. James W. Mold, MD, MPH

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Cancer screening tests are not perfect. Test results may suggest cancer when there is none (false-positive screen). They can also miss cancer even if it is present (false-negative screen). False-positive results can lead to emotional stress and more testing without improving health. Screening tests may also lead to overdiagnosis. Overdiagnosis is when screening tests find slow-growing forms of cancer that would never have caused symptoms or affected health if left undetected.

Author/s:

Zhang, Grace, Incze, Michael

Cervical cancer screening guideline for individuals at average risk

Bethie Seay — Sun, 14 Nov 2021 06:00:00 +0000

Date Added:

November 14, 2021

Journal/Publication:

JAMA

Publication Date:

November 12, 2021

Type:

Meta-analyses, Reviews, and Guidelines

DOI (1):

10.1001/jama.2021.13448

MeSH

female

Adult

aged

uterine cervical neoplasms

early detection of cancer

Papillomavirus Infections

American Cancer Society

The American Cancer Society’s most recent recommendations regarding cervical cancer screening.

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Major recommendations

Begin screening at age 25 years regardless of sexual history or HPV vaccination status (strong recommendation)

Primary HPV testing every 5 years through age 65 years (strong recommendation)

If primary HPV testing is not available use cotesting (HPV+ cytology) every 5 years or every 3 years if cytology only (strong recommendation)

Discontinue screening at age 65 years if no history of cervical intraepithelial neoplasia grade 2 or more severe diagnosis in last 25 years and adequate negative prior screening in last 10 years (qualified recommendation)

Author/s:

Chor, J., Davis, A. M., Rusiecki, J. M.

Screening for Lung Cancer US Preventive Services Task Force Recommendation Statement

Devin Evans — Wed, 24 Mar 2021 05:00:00 +0000

Date Added:

March 24, 2021

Journal/Publication:

Journal of the American Medical Association

Publication Date:

March 9, 2021

Issue:

Volume:

325

Pages:

962-970

URL:

Screening for Lung Cancer US Preventive Services Task Force Recommendation Statement

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2021.1117

Keywords

tobacco

smoking

Cancer Screeing

PMID (1):

33687470

MeSH

smoke

Tobacco Smoke Pollution

early detection of cancer

Updated USPSTF recommendation regarding screening for lung cancer. James W. Mold, MD, MPH

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Importance: Lung cancer is the second most common cancer and the leading cause of cancer death in the US. In 2020, an estimated 228 820 persons were diagnosed with lung cancer, and 135 720 persons died of the disease. The most important risk factor for lung cancer is smoking. Increasing age is also a risk factor for lung cancer. Lung cancer has a generally poor prognosis, with an overall 5-year survival rate of 20.5%. However, early-stage lung cancer has a better prognosis and is more amenable to treatment.

Objective: To update its 2013 recommendation, the US Preventive Services Task Force (USPSTF) commissioned a systematic review on the accuracy of screening for lung cancer with low-dose computed tomography (LDCT) and on the benefits and harms of screening for lung cancer and commissioned a collaborative modeling study to provide information about the optimum age at which to begin and end screening, the optimal screening interval, and the relative benefits and harms of different screening strategies compared with modified versions of multivariate risk prediction models.

Population: This recommendation statement applies to adults aged 50 to 80 years who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years.

Evidence assessment: The USPSTF concludes with moderate certainty that annual screening for lung cancer with LDCT has a moderate net benefit in persons at high risk of lung cancer based on age, total cumulative exposure to tobacco smoke, and years since quitting smoking.

Recommendation: The USPSTF recommends annual screening for lung cancer with LDCT in adults aged 50 to 80 years who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years. Screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery. (B recommendation) This recommendation replaces the 2013 USPSTF statement that recommended annual screening for lung cancer with LDCT in adults aged 55 to 80 years who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years.

Author/s:

US Preventive Services Task Force

Patient-Reported Needs Following a Referral for Colorectal Cancer Screening

Brian Desmarais — Tue, 29 Sep 2020 13:30:42 +0000

Date Added:

September 29, 2020

Journal/Publication:

American Journal of Preventive Medicine

Publication Date:

February 1, 2019

URL:

Patient-Reported Needs Following a Referral for Colorectal Cancer Screening

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1016/j.amepre.2018.08.017. Epub 2018 Dec 13.

MeSH

decision support techniques

early detection of cancer

Physician-Patient Relations

patient acceptance of healthcare

Patients referred for colonoscopy have lots of questions that are not always being answered by primary care clinicians. Many would appreciate being able to access additional information through the the practice’s portal. James W. Mold, MD, MPH

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Abstract

Introduction: Patient-physician communication about colorectal cancer screening can affect screening use, but discussions often lack information that patients need for informed decision making and seldom address personal preferences or barriers. To address this gap, a series of patient focus groups was conducted to guide the development of an online, interactive decision support program. This article presents findings on patient information needs and barriers to colorectal cancer screening after receiving a screening recommendation from a physician, and their perspectives on using electronic patient portals as platforms for health-related decision support.

Methods: Primary care patients with recent colonoscopy or stool testing orders were identified via the centralized data repository of a large Midwestern health system. Seven gender-stratified focus groups (N=45 participants) were convened between April and July 2016. Sessions were audio recorded, transcribed, coded, and analyzed for commonly expressed themes beginning in August 2016.

Results: Findings reveal a consistent need for simple and clear information on colorectal cancer screening. Participants desired step-by-step explanations of the colonoscopy procedure and information about bowel preparation options/alternatives. The desired level of additional information varied: some patients wanted to know about and act on test options, whereas others preferred following their physician-recommended testing path. Fears and concerns were prevalent, particularly about colonoscopy, and patients reported challenges getting these concerns and their informational needs addressed. Finally, they expressed consistent support for using the patient portal to gather additional information from their physician.

Conclusions: Patient portals may offer an opportunity to build sustainable programs for decision support and assistance that are integrated with clinic workflows and processes.

Trial registration: ClinicalTrials.gov NCT02798224.

Author/s:

Dyer, Karen E., Shires, Deirdre A.

Association Between Age and Complications After Outpatient Colonoscopy

Brian Desmarais — Mon, 29 Jun 2020 16:48:40 +0000

Date Added:

June 29, 2020

Journal/Publication:

JAMA network open

Publisher:

Journal of American Medical Association

Publication Date:

June 1, 2020

URL:

Association Between Age and Complications After Outpatient Colonoscopy

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1001/jamanetworkopen.2020.8958

MeSH

renal insufficiency, chronic

hospitalization

Inflammatory Bowel Diseases

early detection of cancer

risk factors

cohort studies

incidence

retrospective studies

The risk of major complications of colonoscopy is greater for liver disease (odds ratio [OR], 4.7; 95% CI, 3.5-6.5) smokers (OR, 3.2; 95% CI, 2.4-4.3), patients who are obese (OR, 2.3; 95% CI, 1.2-4.2), and patients who are over 75 years of age (OR, 2.3; 95% CI, 2.0-2.6). James W. Mold, MD, MPH

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Abstract

Importance: There are insufficient data describing the incidence and risk factors of postcolonoscopy complications in older individuals.

Objective: To assess the association between older age (≥75 years) and the risk of postcolonoscopy complications.

Design, setting, and participants: This population-based retrospective cohort study included adults (≥50 years) undergoing outpatient colonoscopy between April 2008 and September 2017, identified from Ontario administrative databases. Individuals with inflammatory bowel disease and hereditary colorectal cancer syndromes were excluded. The study population was subdivided into a colorectal cancer screening-eligible cohort (patients aged 50-74 years) and an older cohort (patients aged ≥75 years). The statistical analysis was conducted from December 2018 to September 2019.

Exposures: Older age (≥75 years).

Main outcomes and measures: The primary outcome was postcolonoscopy complications, defined as the composite of hospitalization or emergency department visits in the 30-day period after the outpatient colonoscopy. Secondary outcomes included incidence of surgically treated colorectal cancer and all-cause mortality at 30 days. Independent variables associated with postcolonoscopy complications were also assessed.

Results: The study sample included 38 069 patients; the mean (SD) age was 65.2 (10.1) years, there were 19 037 women (50.0%), and 27 831 patients (73.1%) underwent a first colonoscopy. The cumulative incidence of complications was 3.4% (1310 patients) in the overall population, and it was higher in individuals aged 75 years or older (515 of 7627 patients [6.8%]) than in screening-eligible cohort (795 of 30 443 patients [2.6%]) (P < .001). Independent risk factors for postcolonoscopy complications were age 75 years or older (odds ratio [OR], 2.3; 95% CI, 2.0-2.6), anemia (OR, 1.4; 95% CI, 1.2-1.7), cardiac arrhythmia (OR, 1.7; 95% CI, 1.2-2.2), congestive heart failure (OR, 3.4; 95% CI, 2.5-4.6), hypertension (OR, 1.2; 95% CI, 1.0-1.5), chronic kidney disease (OR, 1.8; 95% CI, 1.1-3.0), liver disease (OR, 4.7; 95% CI, 3.5-6.5), smoking history (OR, 3.2; 95% CI, 2.4-4.3), and obesity (OR, 2.3; 95% CI, 1.2-4.2). The number of previous colonoscopies was associated with a lower risk of complications (OR, 0.9; 95% CI, 0.7-1.0). The incidence of surgically treated colorectal cancer was higher in the older cohort than the screening-eligible cohort (119 patients [1.6%] vs 144 patients [0.5%]; P < .001). All-cause mortality rates were 0.1% overall (39 patients) and 0.1% (19 patients) for individuals aged 50 to 74 years and 0.2% (20 patients) for those aged 75 years and older (P < .001).

Conclusions and relevance: In this population-based cohort study of individuals living in southern Ontario, age of 75 years and older was associated with a higher risk of 30-day postprocedure complications after outpatient colonoscopy. These findings suggest that the decision to perform a colonoscopy should be carefully considered in patients older than 75 years, especially in the presence of comorbidities. Further studies are needed to better understand the benefits of invasive procedures as opposed to less invasive approaches for colorectal cancer screening and surveillance among older patients.

Author/s:

Causada-Calo, N., Bishay, K., Albashir, S., Mazroui, A.A., Armstrong, D.