Cancer Diary: Colonoscopies and Aging—When to Start, When to Stop?

 


Aging brings many questions about medical care, and colonoscopies are no exception. When should you start them? When should you stop? The answers aren’t as straightforward as you might think, especially when family history, anesthesia risks, and individual health concerns come into play.

When to Start and Why?

For most people, the recommended age to begin screening for colorectal cancer is 45 (lowered from 50 in recent years due to increasing cases in younger adults). However, if you have a strong family history—like my siblings and I, who all have had pre-cancerous polyps found at each colonoscopy—you may need to start even earlier.

Doctors recommend earlier and more frequent screenings if you have:

  • A family history of colorectal cancer or pre-cancerous polyps

  • Certain genetic conditions like Lynch Syndrome

  • A history of inflammatory bowel disease (Crohn’s or ulcerative colitis)

When to Stop and Why?

Many doctors advise stopping colonoscopies at 75—but is that the right call for everyone? Some of my friends have been told they no longer need them after that age. Meanwhile, my doctor is planning my next one at 77, and given my family history, that makes sense.

Guidelines suggest discontinuing routine screenings between 75 and 85 based on factors like:

  • Life expectancy (If a person is expected to live another 10+ years, screening may still be beneficial.)

  • Overall health (If a person is in good health, removing pre-cancerous polyps could still prevent cancer.)

  • Personal history of polyps or colorectal cancer (For those with a strong history, like my family, screening beyond 75 may still be valuable.)

After 85, the risks generally outweigh the benefits for most people, and screenings are no longer recommended.

Anesthesia and Colonoscopy Risks in Older Adults

One of the biggest concerns with colonoscopies in later years is anesthesia safety. Many people tolerate light sedation (like propofol) well, but for those of us who require general anesthesia, the risks increase. In older adults, anesthesia can contribute to:

  • Cognitive decline or post-operative delirium

  • Heart or lung complications

  • Longer recovery times

For me, anesthesia is an even bigger challenge because of an allergy to local painkillers, meaning I always require full general anesthesia. That adds another layer of risk, but given my history of pre-cancerous polyps, it’s still worth doing—at least for now.

The Toughest Cases: When Colonoscopy Risks Outweigh Benefits

Not everyone can safely undergo a colonoscopy, even when the risk of cancer is high. My son, an adult with CHARGE Syndrome, falls into this category. CHARGE Syndrome comes with severe anesthesia risks, and one research study found that more than one-third of CHARGE adults had to be placed on life support after being extubated. Because of this, a highly respected gastroenterologist and cancer researcher told me outright: We will not scope him. The risk of the procedure itself is too great.

This highlights an important reality—sometimes, the risk of the screening outweighs the risk of the disease. In cases like my son’s, alternative monitoring methods (stool tests, imaging, or symptom tracking) may be the only safe options.

Final Thoughts: Who Really Needs Colonoscopies in Older Age?

For most people, colonoscopies are essential between ages 45 and 75. After that, the decision should be personalized, considering family history, overall health, and anesthesia risks. For those with a strong history of polyps or colorectal cancer, extending screenings into the late 70s or early 80s might make sense. But for people with severe anesthesia risks or limited life expectancy, stopping earlier may be the safest choice.

As with all cancer screenings, the best approach is an individualized one—because in medicine, one size never truly fits all.

Read more Cancer Diary posts HERE.


Blog editor's note: As a memorial to Carl Leaver, MSI Press graphic arts director and designer, who died of Cancer of Unknown Primary August 16, 2021, and simply because it is truly needed, MSI Press is now hosting a web page, Carl's Cancer Compendium, as a one-stop starting point for all things cancer, to make it easier for those with cancer to find answers to questions that can otherwise take hours to track down on the Internet and/or from professionals. The web page is in its infancy but expected to expand into robustness. To that end, it is expanded and updated weekly. As part of this effort, each week, on Monday, this blog carries an informative, cancer-related story -- and is open to guest posts: Cancer Diary. 



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