Noncancer death outweighs colorectal cancer risk
In adults 75 or older, later colorectal cancer risk is low and is far outweighed by death from other causes, even after a prior precancerous polyp.
*Retrospective cohort study; Level 2b (Oxford evidence scale).

Citation

Gupta S, Liu L, Demb J, et al. Colorectal cancer and mortality risk among older adults with vs without adenoma on prior colonoscopy. JAMA. 2026;335(17):1499-1506. doi:10.1001/jama.2026.3414

Background

Guidelines often discourage repeated screening colonoscopy after age 75 for people with a prior normal colonoscopy, but the long-term cancer risk in those with prior precancerous polyps is uncertain.

Patients

91,952 adults in the United States Department of Veterans Affairs who had a colonoscopy before age 75 (median age at last pre-75 colonoscopy, 71 years; 98% male). Excluded: prior colorectal cancer, inflammatory bowel disease, incomplete exam, or poor/missing bowel preparation documentation.

Intervention

Prior colonoscopy showing 1 or more precancerous polyps (adenomas) before age 75.

Control

Prior colonoscopy without adenomas before age 75.

Outcome

Cumulative incidence of colorectal cancer, death from colorectal cancer, and death from other causes after age 75.

Follow-up Period

From 75th birthday through December 31, 2019 (reported at 10 years).

Results

Outcome at 10 years Prior adenoma No prior adenoma Absolute difference
Colorectal cancer (primary) 1.1% (0.8% to 1.3%) 0.7% (0.5% to 0.8%) +0.4%
Death from colorectal cancer (primary) 0.5% (0.3% to 0.7%) 0.4% (0.3% to 0.5%) +0.1%
Death from other causes by 10 years was about 47% to 48% overall, and among those with prior adenomas it rose from 34% (not frail) to 82% (severely frail), far exceeding cancer risk.

Limitations

Observational design may leave residual differences between groups. The population was almost entirely male veterans, limiting generalizability. Although statistically different, the added 10-year cancer and cancer-death risks were small in absolute terms.

Funding

United States Department of Veterans Affairs and United States National Institutes of Health.

Clinical Application

For most patients 75+, prioritize overall health and frailty over routine surveillance colonoscopy after prior adenomas; consider individualized decisions. Possible indication creep: mostly male veterans.