Letter to the Editor
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Sep 16, 2021; 13(9): 447-450
Published online Sep 16, 2021. doi: 10.4253/wjge.v13.i9.447
Ethical dilemma of colorectal screening: What age should a screening colonoscopy start and stop?
Alla Turshudzhyan, Alexa Trovato, Micheal Tadros
Alla Turshudzhyan, Department of Medicine and Gastroenterology, University of Connecticut, Farmington, CT 06030, United States
Alexa Trovato, Department of Medicine, Albany Medical College, Albany, NY 12208, United States
Micheal Tadros, Department of Gastroenterology and Hepatology, Albany Medical College, Albany, NY 12208, United States
Author contributions: Turshudzhyan A and Trovato A wrote the letter; Tadros M revised the letter.
Conflict-of-interest statement: We have no conflict-of-interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Micheal Tadros, FACG, MD, Associate Professor, Department of Gastroenterology and Hepatology, Albany Medical College, 43 New Scotland Avenue, Albany, NY 12208, United States. tadrosm1@amc.edu
Received: June 3, 2021
Peer-review started: June 3, 2021
First decision: July 16, 2021
Revised: July 17, 2021
Accepted: August 9, 2021
Article in press: August 9, 2021
Published online: September 16, 2021
Abstract

Many advanced age patients who are diagnosed with colorectal cancer are often not offered surgical treatment due to presumed high risks of the procedure. While there is data to support surgical treatment of colorectal cancer in advanced age patients, screening colonoscopy is not currently recommended for patients older than 85 years. Moreover, recent studies concluded that the incidence of colorectal cancer in patients 80 years and older is increasing. This raises the concern that the current guidelines are withholding screening colonoscopy for healthy elderly patients. Another concern contrary to this would be the new trend of growing incidence of advanced colorectal cancer in the younger patient population. Together they raise the ethical dilemma of how to best utilize colonoscopies as well as surgical intervention, as they are limited resources.

Keywords: Colonoscopy, Colorectal cancer, Screening, Advanced age patient, Screening colonoscopy

Core Tip: Flynn et al collected data on surgery in colorectal cancer patients who are 85 years or older. They concluded that surgery in this patient population is safe, and that age alone is not a reason to withhold surgery. The incidence of colorectal cancer in patients 80 years and older is increasing. This raises the concern that the current guidelines are withholding screening colonoscopy for healthy elderly patients. On the other hand, a greater number of younger patients are being diagnosed with colorectal cancer. This raises an inevitable ethical dilemma of how to best utilize screening and treatment resources.