Standard guidelines for stopping colon screening
For average-risk adults, major health organizations provide clear recommendations on when to continue and when to consider stopping colorectal cancer (CRC) screening. The U.S. Preventive Services Task Force (USPSTF) recommends screening adults ages 45 to 75. Similarly, the American Cancer Society (ACS) advises regular screening for average-risk individuals from age 45 through 75, provided they are in good health with a life expectancy of more than 10 years. After age 75, the approach shifts from routine screening to a more personalized assessment.
The individualized approach for ages 76 to 85
For individuals between the ages of 76 and 85, the decision to continue or discontinue screening becomes highly individualized. Clinicians and patients are advised to discuss the potential risks and benefits, considering overall health, prior screening history, life expectancy, and patient preference.
Stopping screening after age 85
Most guidelines, including those from the American Cancer Society and the U.S. Multi-Society Task Force on Colorectal Cancer, recommend that average-risk individuals over the age of 85 should no longer get screened. After this age, the risks associated with the screening procedure are more likely to outweigh the potential benefits, as serious adverse events from colonoscopies increase with age.
Comparison of screening cutoff recommendations
Different medical organizations have slight variations in their guidelines, but the overall approach for older adults is consistent. The following table summarizes recommendations for average-risk individuals.
| Health Organization | Routine Screening (Average Risk) | Ages 76-85 | Ages 86+ |
|---|---|---|---|
| American Cancer Society (ACS) | Ages 45-75 | Individualized decision based on factors like health and life expectancy | Not recommended |
| U.S. Preventive Services Task Force (USPSTF) | Ages 45-75 | Selectively offer screening based on overall health, prior screening, and patient preferences | Evidence suggests small or no net benefit |
| U.S. Multi-Society Task Force (MSTF) | Start at age 45 for average-risk individuals | Individualized decision based on factors like prior screening and life expectancy | Not recommended |
The shift from age-based to risk-based evaluation
Guidelines are moving towards an individualized, risk-based assessment that weighs the benefits of detection against the increasing risks of complications from procedures for older adults.
Screening modalities and their role in the decision
Less invasive stool-based tests may be options for some older adults, though their specificity might decrease with age. A healthcare provider can help determine the best approach.
Conclusion
At what age do colon screenings stop is an individualized decision. While routine screening is recommended through age 75 and generally stops after 85, the period between requires considering health, life expectancy, prior screening, and personal preferences with a healthcare provider.
