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Personalized approach suggested on colorectal cancer screening

Conventional age-based guidelines for screening do not account for health status, life expectancy, UT Southwestern researchers find

Colon cancer, illustration
The current guidelines for colorectal cancer screening are based on age and do not take into account individual life expectancy or other comorbidities. (Photo credit: Getty Images)

DALLAS – Nov. 28, 2023 – Colorectal cancer (CRC) screening rates are similar among older adults despite varying 10-year mortality risks, UT Southwestern Medical Center researchers report in a new study. The findings, published in The American Journal of Gastroenterology, challenge conventional age-based recommendations for CRC screening that don’t take into account factors like individual life expectancies and comorbidities.

Amit Singal, M.D., M.S.
Amit Singal, M.D., M.S., Professor of Internal Medicine in the Division of Digestive and Liver Diseases, is a member of the Peter O'Donnell Jr. School of Public Health and the Harold C. Simmons Comprehensive Cancer Center at UT Southwestern. Dr. Singal is also Medical Director of the UTSW Liver Tumor Program, Chief of Hepatology, and a Dedman Family Scholar in Clinical Care.

“We were surprised to see little difference in colorectal cancer screening rates across life expectancy groups despite patients having differences in the anticipated risk-benefit ratio of the procedure,” said co-senior author Amit Singal, M.D., M.S., Professor of Internal Medicine in the Division of Digestive and Liver Diseases and member of the Harold C. Simmons Comprehensive Cancer Center at UT Southwestern. Dr. Singal is also Medical Director of the UTSW Liver Tumor Program, Chief of Hepatology, and a Dedman Family Scholar in Clinical Care. 

The research revealed the potentially significant benefits of updating the current CRC guidelines, which call for screenings based primarily on age starting at 45 and stopping at 75. A more personalized approach, which considers a person’s health status and risk of dying in the next 10 years, would ensure that both older, healthier adults and younger individuals with chronic conditions receive the appropriate level of screening.

“Our results suggest incorporating life expectancies and comorbidities into current age-based recommendations for colorectal cancer screening,” said Po-Hong Stuart Liu, M.D., M.P.H., Clinical Research Fellow in the Division of Digestive and Liver Diseases at UT Southwestern and the study’s first author. “The traditional one-size-fits-all approach doesn’t account for the varying health statuses and life expectancies of older adults, potentially leading to underscreening and overscreening.”

Po-Hong Stuart Liu, M.D., M.P.H.
Po-Hong Stuart Liu, M.D., M.P.H., Clinical Research Fellow in the Division of Digestive and Liver Diseases at UT Southwestern, is the study's first author.

The study analyzed the behaviors of 25,888 adults, ages 65-84, who were not up to date with CRC screening based on National Health Interview Survey data. The researchers specifically focused on screening for colorectal cancer within the past year, which included any recommended CRC screening test. They found that the prevalence of these screenings remained consistent, ranging from 35.4% to 40.6% across various 10-year mortality risk categories, offering compelling evidence for revising the existing age-based framework.

With the growing incidence of CRC diagnoses after age 65 and the number of those adults projected to increase from 55.8 million in 2020 to 81 million in 2040, the findings drive home the importance of identifying older patients who may benefit from screening while simultaneously identifying those younger than 75 who may not benefit from the same screening measures.

“Beyond implications for CRC screening guidelines, our data reinforce the importance of providers considering whether patients can truly derive long-term benefits from screening,” Dr. Singal noted. “Specifically, screening is unlikely to be of benefit in patients with a high competing risk of mortality from other medical conditions.”

The study was funded by grants from the National Institutes of Health (R01CA242558 and T32DK007745).

Dr. Singal is a member of the Peter O’Donnell Jr. School of Public Health and holds the Willis C. Maddrey, M.D. Distinguished Chair in Liver Disease.

About UT Southwestern Medical Center

UT Southwestern, one of the nation’s premier academic medical centers, integrates pioneering biomedical research with exceptional clinical care and education. The institution’s faculty members have received six Nobel Prizes and include 26 members of the National Academy of Sciences, 20 members of the National Academy of Medicine, and 13 Howard Hughes Medical Institute Investigators. The full-time faculty of more than 3,100 is responsible for groundbreaking medical advances and is committed to translating science-driven research quickly to new clinical treatments. UT Southwestern physicians provide care in more than 80 specialties to more than 120,000 hospitalized patients, more than 360,000 emergency room cases, and oversee nearly 5 million outpatient visits a year.