Benefit of Continued Surveillance Colonoscopy in Adults 75 Years or Older is Limited, Finds JAMA Study
USA: Researchers have found in a new study that among adults aged 75 years or older with a history of adenoma, the risk of developing colorectal cancer (CRC) and CRC-related mortality is higher compared to those without prior adenoma. However, the overall absolute risk remains low and is significantly outweighed by the higher likelihood of death from non-CRC causes. This suggests that the benefit of continued surveillance colonoscopy in this age group is limited, and clinical decisions should prioritize overall health status, comorbidities, and patient preferences rather than routine surveillance alone.
The JAMA study by Samir Gupta (VA San Diego Healthcare System, California) and colleagues examined long-term outcomes in adults aged 75 years or older with and without prior adenoma. The study assessed risks of colorectal cancer (CRC), CRC-related death, and overall mortality in this population, where routine screening is often reconsidered.
For this purpose, the researchers conducted a large retrospective cohort study using data from the US Department of Veterans Affairs. The analysis included 91,952 individuals who underwent colonoscopy before age 75 between 2006 and 2019. Of these, 27.8% had prior adenoma and 72.2% did not. Participants were followed for up to 10 years to evaluate CRC incidence, CRC-specific mortality, non-CRC mortality, and all-cause mortality.
The following were the key findings:
- Individuals with prior adenoma had a slightly higher 10-year cumulative incidence of colorectal cancer compared to those without adenoma (1.1% vs 0.7%).
- CRC-related mortality was also marginally higher in the adenoma group (0.5% vs 0.4%).
- Despite these differences, the overall absolute risks of CRC incidence and mortality remained low in both groups.
- Deaths due to non-CRC causes were substantially higher, reaching approximately 47% to 48% over 10 years.
- Among individuals with prior adenoma, the risk of non-CRC death consistently exceeded the risk of developing colorectal cancer across all frailty categories.
- Non-CRC mortality varied widely with frailty, from 34.2% in nonfrail individuals to 82.0% in those with severe frailty.
The findings indicate that competing health risks—particularly non-CRC mortality—predominate in this older population.
Although prior adenoma is linked to a slightly higher risk of CRC and related death, the absolute risk remains low and is far outweighed by mortality from other causes. This supports a more individualized approach to surveillance colonoscopy in adults aged 75 years or older.
The authors noted limitations, including a predominantly male US veteran population, which may restrict generalizability. In addition, the study could not fully evaluate the impact of follow-up colonoscopy due to limited data on the indications for repeat procedures.
Overall, the results suggest that in older adults, especially those with comorbidities or frailty, the benefits of continued surveillance colonoscopy may be limited. Screening decisions should therefore be guided by overall health status rather than prior adenoma history alone.
Reference:
Gupta S, Liu L, Demb J, et al. Colorectal Cancer and Mortality Risk Among Older Adults With vs Without Adenoma on Prior Colonoscopy. JAMA. Published online April 09, 2026. doi:10.1001/jama.2026.3414USA: Researchers have found in a new study that among adults aged 75 years or older with a history of adenoma, the risk of developing colorectal cancer (CRC) and CRC-related mortality is higher compared to those without prior adenoma. However, the overall absolute risk remains low and is significantly outweighed by the higher likelihood of death from non-CRC causes. This suggests that the benefit of continued surveillance colonoscopy in this age group is limited, and clinical decisions should prioritize overall health status, comorbidities, and patient preferences rather than routine surveillance alone.
The JAMA study by Samir Gupta (VA San Diego Healthcare System, California) and colleagues examined long-term outcomes in adults aged 75 years or older with and without prior adenoma. The study assessed risks of colorectal cancer (CRC), CRC-related death, and overall mortality in this population, where routine screening is often reconsidered.
For this purpose, the researchers conducted a large retrospective cohort study using US Department of Veterans Affairs data. The analysis included 91,952 individuals who underwent colonoscopy before age 75 between 2006 and 2019. Of these, 27.8% had prior adenoma and 72.2% did not. Participants were followed for up to 10 years to evaluate CRC incidence, CRC-specific mortality, non-CRC mortality, and all-cause mortality.
The following were the key findings:
- Individuals with prior adenoma had a slightly higher 10-year cumulative incidence of colorectal cancer compared to those without adenoma (1.1% vs 0.7%).
- CRC-related mortality was also marginally higher in the adenoma group (0.5% vs 0.4%).
- Despite these differences, the overall absolute risks of CRC incidence and mortality remained low in both groups.
- Deaths due to non-CRC causes were substantially higher, reaching approximately 47% to 48% over 10 years.
- Among individuals with prior adenoma, the risk of non-CRC death consistently exceeded the risk of developing colorectal cancer across all frailty categories.
- Non-CRC mortality varied widely with frailty, from 34.2% in nonfrail individuals to 82.0% in those with severe frailty.
The findings indicate that competing health risks—particularly non-CRC mortality—predominate in this older population.
Although prior adenoma is linked to a slightly higher risk of CRC and related death, the absolute risk remains low and is far outweighed by mortality from other causes. This supports a more individualized approach to surveillance colonoscopy in adults aged 75 years or older.
The authors noted limitations, including a predominantly male US veteran population, which may restrict generalizability. In addition, the study could not fully evaluate the impact of follow-up colonoscopy due to limited data on the indications for repeat procedures.
Overall, the results suggest that in older adults, especially those with comorbidities or frailty, the benefits of continued surveillance colonoscopy may be limited. Screening decisions should therefore be guided by overall health status rather than prior adenoma history alone.
Reference:
Gupta S, Liu L, Demb J, et al. Colorectal Cancer and Mortality Risk Among Older Adults With vs Without Adenoma on Prior Colonoscopy. JAMA. Published online April 09, 2026. doi:10.1001/jama.2026.3414
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