Published online Sep 15, 2019. doi: 10.4251/wjgo.v11.i9.729
Peer-review started: March 15, 2019
First decision: June 5, 2019
Revised: June 7, 2019
Accepted: July 26, 2019
Article in press: July 29, 2019
Published online: September 15, 2019
Processing time: 184 Days and 16.8 Hours
Elderly patients aged at least 75 years old (Elderly_75), represent 45% of colorectal cancer (CRC) incidence. As others, the French Colorectal Cancer Screening Program (CRCSP) does not include Elderly_75. To date, there is little evidence to justify stopping screening at 74 years of age.
To describe CRC fecal screening test completion after age 74, source (CRCSP/Provider ordered) and outcomes of these tests.
The study concerned 18704 Elderly_75 residing in eleven French districts (Ain, Doubs, Essonne, Haute-Saone, Hauts-de-Seine, Jura, Seine-Saint-Denis, Territoire-de-Belfort, Val-de-Marne, Val-d’Oise, Yonne), having performed a CRC screening test between January 2008 and December 2017. The tests performed in a circumstance of delayed response to a solicitation (DRS) from the local cancer screening managing center (Managing-Center) were distinguished from the tests non-solicited by the Managing-Center, performed after a recommendation by a General Practitioner (GP) or other provider ordered (RGP). DRS was any test realized by an Elderly_75 following an initial invitation from the Managing-Center with a maximum 24 mo after this invitation. Any Non-DRS test was considered RGP. The outcomes of these tests were described according to the circumstances of test completion.
Of 18995 screening-tests were performed at ages: 75 (83.5%), 76-80 (13.4%) and > 80 (3.1%) years old. Elderly_75 performed the screening test in a circumstance of DRS (71.9%) or RGP (28.1%). The proportion of the tests that could not be analyzed and not restarted was 13.2%. For these unanalyzed tests, the reason was age-related in 78.0% of cases, related to the laboratory’s refusal to analyze the test of people aged ≥ 77. Reported colonoscopy completion rate was 81.3%. For those 575 people with reported colonoscopy, no complication was listed. 18.0% of the 366 Elderly_75 with lesions had no anteriority in the CRCSP. The neoplasia (124 Low-risk-polyps, 159 High-risk-polyps, 13 Unspecified-polyps and 70 CRCs) detection rate was 19.3/1000 Elderly_75 screened and the CRC detection rate was 3.7/1000 Elderly_75 screened.
The high rate of colonoscopy completion after a positive test and the high proportion of screened lesions observed suggest that the lengthening of the screening period could allow significant detection of CRC and polyps that occur in Elderly_75 excluded from CRCSP.
Core tip: Reported colonoscopy completion rate was 81.3% and the neoplasia detection rate was 19.3 per 1000 Elderly screened and the colorectal cancer detection rate was estimated at 3.7 per 1000 Elderly screened. These results remain significantly higher than that usually found in the French Colorectal Cancer Screening Program (CRCSP). The motivation to participate including for colonoscopy and the high proportion of screened lesions sufficiently demonstrate that the lengthening of the follow-up period in a screening program, up to about 80 years of age, could make it possible to detect many cases that occur after the exclusion of Elderly_75 from CRCSP.