The effectiveness of endoscopy screenings for stomach and colon cancer in individuals aged 80 and over has been found to be unclear. This suggests that for this age group, the decision to undergo screening should be individualized based on personal health status rather than being a routine procedure.
The National Evidence-based Healthcare Collaborating Agency (NECA) announced on the 16th that a research team led by Professor Kim Hyun-soo of Wonju Severance Christian Hospital has published results of a clinical value assessment for stomach and colon cancer screening, with support from the Patient-centered Medical technology Optimization Research group (PACEN). A clinical value assessment is an evaluation where various stakeholders review major research findings from multiple perspectives to help the public and patients choose rational medical services.
Currently, the National Cancer Screening Program provides colorectal cancer screening for individuals aged 50 and over every 1-2 years via a fecal occult blood test. A colonoscopy is recommended if the test result is positive. For stomach cancer, screening is offered every two years to those aged 40 and over through either a gastroscopy or an upper gastrointestinal series. There are no upper age limits for either endoscopy screening.
The research team analyzed health insurance claims data from 2004 to 2020 for 19,000 screened individuals and 19,000 unscreened individuals aged 75 and over. The results showed that for those up to age 79, undergoing a colonoscopy reduced the incidence of colorectal cancer by 30%. For those aged 80 and over, no correlation was observed between endoscopy screening and the prevention of colorectal cancer.
In an analysis of National Cancer Screening data from 2009 to 2020, which included 86,000 screened and 86,000 unscreened individuals aged 75 and over, gastroscopy was found to reduce stomach cancer mortality by 43% for people up to age 79. For those aged 80 and over, the mortality reduction effect was relatively lower. When the team analyzed the data in one-year increments to determine an upper age limit, the effectiveness of gastroscopy became inconclusive from age 81 onwards.
Based on these research findings, the experts who conducted the clinical value assessment stated, “For individuals aged 80 and over, a blanket recommendation for screening is not advisable. The decision should be made on a case-by-case basis, considering the individual's health status, life expectancy, and cancer risk.” They added, “'Shared decision-making,' where patients and medical staff thoroughly discuss the matter before deciding on an endoscopy, is crucial.” The clinical value assessment report can be found on the PACEN website.
According to current guidelines from domestic academic societies, a colonoscopy is recommended as an optional procedure for individuals aged 81 and over, while gastroscopy is not recommended for those aged 85 and older due to a potential to increase mortality. This new study lowers that age threshold, advising against routine screening for individuals aged 80 and over.
