Colorectal cancer (CRC) is the fourth leading cause of cancer and second leading cause of mortality from cancer in the United States. As the population ages, decisions regarding the initiation and cessation of screening and surveillance for CRC are of increasing importance. In elderly patients, the risks of CRC and the presenting signs and symptoms are similar to those in younger patients. Screening and ongoing surveillance should be considered in patients who have a life expectancy of 10 years or more. Life expectancy estimates can be calculated using online calculators. If screening is deemed appropriate, the choice of which test to use first is unclear. Currently, there are a number of modalities available to screen for CRC, including both invasive modalities (eg, colonoscopy, sigmoidoscopy, capsule colonoscopy, and computed tomographic colonography) and noninvasive modalities (fecal immunochemical test, stool DNA testing, and blood testing). Colonoscopy and other invasive testing options are considered safe, but the risks of complications of the bowel preparation, the procedure, and sedation medications are all increased in older patients. In contrast, noninvasive testing provides a safe initial test; however, it is important to consider the increased false-positive rates in the elderly, and a positive test result will usually necessitate colonoscopy to establish the diagnosis. Ongoing screening and surveillance should be a shared decision-making process with the patient based on multiple factors including the patient's morbidity and mortality risk from CRC and his or her underlying comorbidities, the patient's functional status, and the patient's preferences for screening. Ultimately, the decision to initiate or discontinue screening for CRC in older patients should be done based on a case-by-case individualized discussion.

中文翻译：

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筛查老年人结肠癌：风险，益处和何时停止。

在美国，结直肠癌（CRC）是癌症的第四大主要原因，也是死于癌症的第二大主要原因。随着人口老龄化，关于开始和停止对CRC进行筛查和监测的决定越来越重要。在老年患者中，CRC的风险以及出现的体征和症状与年轻患者相似。预期寿命为10年或以上的患者应考虑进行筛查和持续监测。可以使用在线计算器来计算预期寿命。如果认为筛查是适当的，则不清楚先选择哪种测试。目前，有多种筛查CRC的方法，包括两种侵入性方法（例如，结肠镜检查，乙状结肠镜检查，胶囊结肠镜检查，以及计算机断层扫描结肠造影）和非侵入性检查方式（粪便免疫化学检测，粪便DNA检测和血液检测）。结肠镜检查和其他侵入性检查选项被认为是安全的，但老年患者肠道准备，手术和镇静药物并发症的风险均增加。相比之下，非侵入性测试提供了安全的初始测试。然而，重要的是要考虑到老年人假阳性率的增加，并且测试结果阳性通常需要进行结肠镜检查来确定诊断。正在进行的筛查和监视应该是与患者共享的决策过程，应基于多种因素，包括患者的CRC发病率和死亡风险以及他或她的潜在合并症，患者的功能状态，以及患者对筛查的偏爱。最终，应根据具体情况逐个讨论开始或终止老年患者CRC筛查的决定。