COLORECTAL cancer (CRC) screening guidelines may need to be more tailored, according to new research that identifies optimal stopping ages for screening based on sex, comorbidity status, and prior screening history. These findings aim to improve cost-effectiveness and patient-centered care in the United States.
In a recently published study, researchers used an economic simulation model validated with real-world community data to assess the cost-effectiveness of continuing CRC screening in individuals aged 76 to 90. The study considered two common screening modalities: fecal immunochemical testing (FIT) and colonoscopy.
The research revealed that the optimal stopping age for CRC screening depends on multiple factors, including the patient’s sex, comorbidity level, and the timing and results of prior screenings. For example:
Colonoscopy: The optimal stopping ages ranged from under 76 years to 86 years.
FIT: Stopping ages ranged from under 76 years to 88 years.
For 76-year-old females without comorbidities and a negative colonoscopy 10 years earlier, an additional colonoscopy cost 38,226 per USD quality-adjusted life-year gained (QALYG). However, this cost increased significantly with age and comorbidities, reaching 1.7 million per QALYG for 90-year-old females with the same screening history.
Similarly, the cost-effectiveness of FIT varied with patient characteristics. For females aged 76 years with severe comorbidities and a negative colonoscopy 10 years prior, the incremental cost-effectiveness ratio exceeded $100,000 per QALYG—the threshold for cost-effectiveness in this study.
This research highlights the diminishing returns of CRC screening in older adults with severe comorbidities or recent negative screening results. For healthcare providers, these findings emphasize the importance of personalized decision-making in CRC screening.
The results suggest that universal age-based recommendations may need refinement to better reflect individual patient risks and benefits. Incorporating patient sex, health status, and screening history into decision-making could improve resource allocation while minimizing unnecessary procedures.
With CRC screening becoming increasingly precise, these findings underscore the need for guideline updates to support patient-centered care and cost-effective practices. Tailoring recommendations by age, sex, and comorbidity can help healthcare professionals provide the most appropriate care for their patients.
Reference: Harlass M et al. Optimal Stopping Ages for Colorectal Cancer Screening. JAMA Netw Open. 2024;7(12):e2451715.
Anaya Malik | AMJ
