When should screening colonoscopy not be offered or surveillance stopped?
Evidence suggests that the risks of colonoscopy increases with advancing age. Surveillance and screening should not be continued when risks outweigh the benefits. The United States Preventive Services Task Force (USPSTF) determined that screening should not be continued after age 85 years because the risk could exceed potential benefit. For patients aged 75 to 85 years, the USPSTF recommends against continued routine screening but argues for individualization based on comorbidities and findings of any prior colonoscopy. Patients with HRA are at higher risk for developing advanced neoplasia compared with average-risk patients and therefore the potential benefit of surveillance could be higher than for screening in these individuals.