Background: USPSTF recommends against continuing screening for colorectal cancer (CRC) past 75 years in adequately screened individuals. Research has shown that onetime screening for elderly who have never been screened appears to be cost effective until 86 years of age. Survival and staging data that compare elderly vs younger populations has not been published.
Objective: (1) To compare staging (0-4) of CRC in groups of 60-69, 70-79, and 80 to 89-year-olds; (2) To compare survival outcomes (5-10 years) in stages 0-2 for these age groups after treatment (ie, surgery); (3) To compare surgical and no treatment (ie, no surgery) survival outcomes in these age groups
Methods: Male veterans were selected from Veterans Affairs National Cancer Cube Registry. 22,735 patients within 60-69, 18,390 within 70-79 and 10,057 within 80-89 years were diagnosed with CRC within years 2000-2015 with majority being stages 1 and 2. Surgical and survival data were obtained only for stage 0-2 as surgery is currently the standard of treatment for these stages.
Results: After surgery, 5- to 10-year survival for 60-69 age group averaged about 34.4% (95% CI, 31.94-36.85) for stage 0-2. Similarly, for 70-79 and 80-89 age group it was 30.86% (95% CI, 29.54-32.19) and 25.45% (95% CI, 24.77-25.69), respectively. The 5- to 10-year survival data for patients not undergoing surgery was 1.03%, 0.81%, and 0.95% for age groups 60-69, 70-79 and 80-89, respectively.
Conclusions: The highest number of CRC cases diagnosed across each age group was stage 1 with stage 2 being second. In the surgical treatment group survival was statistically different for 80-89 age group as compared to 60-69 and 70-79, though octogenarians did have a surprisingly high mean of 25.45% suggesting early detection and treatment will help survival. Survival data from no-treatment cases showed an immense drop in survival for patients not undergoing surgery, suggesting that these candidates may have other reasons or comorbid conditions leading to their demise.