Assessing the appropriateness of colorectal cancer screening in very elderly women: A cross-sectional analysis

The Canadian Task Force on Preventive Health Care recommends against screening for colorectal cancer after age 75. This recommendation is based in part on lag time to mortality benefit and a reduced life expectancy in the very elderly. To explore the extent to which screening for colorectal cancer is appropriately ordered in primary care, we performed a cross sectional study in women aged 80-84 at an academic family medicine clinic in Montreal. Appropriateness was assessed using a validated life expectancy calculator, with a 10-year life expectancy of >50% serving as the threshold for appropriateness. Among women 80-84 years of age under the care of a physician in 2016 (N=144), 95 fecal immunochemical tests were ordered from 2016-2019. Of these, 41 were screening tests, and 16/41 (39%; 95% CI 24% to 54%) were deemed to be inappropriate. This finding suggests a need to improve screening decisions for elderly women followed in primary care.