Recommendations for surveillance colonoscopies in older adults with prior adenomas vary based on several factors, including patient age, health, adenoma risk, and physician specialty, according to a national survey.
For prior adenomas, high risk involved five tubular adenomas, one of which was 15 mm, and low risk involved two tubular adenomas, both of which were less than 10 mm. The survey also noted that the recommended surveillance intervals were 3 years in the high-risk scenario and 7 years in the low-risk scenario.
About 20.6% of physicians recommended surveillance if the patient was 85, compared with 49.8% if the patient was 75. In addition, 7.1% of physicians recommended surveillance if the patient was in poor health, compared with 28.8% for those in moderate health, and 67.7% for patients in good health. In general, family medicine and general practice physicians were most likely to recommend surveillance, at 40%, and gastroenterologists were least likely to recommend surveillance, at 30.9%. Patient age and health had larger effects among gastroenterologists than among primary care physicians, and adenoma risk had similar effects between the two groups.
"Current guidelines on surveillance colonoscopies are solely based on prior adenoma characteristics," the authors write."Guidelines need to incorporate guidance that considers patient age and health status, as well as adenoma risk, and explicitly considers when surveillance should stop in older adults."
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