Should people over 75 continue colonoscopies?

For many older adults, the routine colonoscopy becomes a difficult question: when do the risks of continued screening outweigh the benefits? A new study offers some clarity, finding that U.S. veterans aged 75 and older who had previously carried precancerous polyps faced a lower risk of dying from colorectal cancer than from other health conditions.

The research, published in JAMA and led by Dr. Samir Gupta, a gastroenterologist at UC San Diego Health and professor of medicine at the University of California San Diego School of Medicine, examined veterans who had previously undergone colonoscopies. While colorectal cancer remains a leading cause of death among older adults, Gupta and his team discovered that by this stage of life, competing health conditions often posed a greater threat.

The finding carries important implications for clinical practice. Current guidelines from the American Cancer Society recommend colorectal cancer screening for adults beginning at age 45 and continuing through age 75. Adults over 75 with a history of precancerous adenomas—polyps that can develop into cancer—are often referred for follow-up colonoscopies. But colonoscopy is not a trivial procedure: it requires sedation, which introduces risks that can be amplified for older adults managing multiple health conditions simultaneously.

The JAMA study suggests that for some patients in this age group, the calculus may have shifted. Rather than blanket recommendations for continued surveillance, the research supports a more individualized approach where patients and their doctors weigh the relatively lower risk of colorectal cancer against other health concerns.

Gupta's work adds to a growing body of evidence encouraging shared decision-making in cancer screening for older adults. As life expectancy increases and medical understanding of aging improves, researchers hope these findings will help patients and physicians have more nuanced conversations about when to continue—and when to potentially step back from—invasive screening procedures.

For veterans and their families navigating these decisions, the research offers a reassuring perspective: for those who have already made it to 75 with a clean bill from their previous colonoscopies, other aspects of health may warrant more attention than continued cancer surveillance.