Association between colonoscopy and colorectal cancer risk in adults aged 75 to 85 years: a nationwide population-based cohort study.

The thresholds on file still hold, and the 2026 AGA Clinical Practice Update (Calderwood, Yoshida, Das, Falk; Clin Gastroenterol Hepatol, online 2026-08-03) agrees with them while adding to them. Average-risk adults are screened routinely from age 45 to 75 (USPSTF 2021: Grade B for 45-49, Grade A for 50-75; USMSTF and ACS agree). For ages 76-85 the decision is individualized (USPSTF Grade C). Under USMSTF, people who are up to date with negative prior screening, especially a high-quality colonoscopy, should consider stopping at 75 or when life expectancy falls below 10 years. People who were never adequately screened may be screened up to 85, depending on age and comorbidity. Screening is not recommended at 86 or older. The 2026 AGA update adds four things. (1) After age 75, the decision to continue screening (BPA 6) or polyp surveillance (BPA 7) should be individualized by weighing benefit, screening or polyp history, comorbidities and risks; this now explicitly covers post-polypectomy surveillance, not only screening. (2) Formal comorbidity assessment and life-expectancy tools may help separate older adults likely to benefit from those likely to be harmed (BPA 1). (3) Colonoscopy adverse events rise with age whatever the indication, so the reasoning behind any colonoscopy decision in someone over 75 should be documented in the EHR (BPA 8). (4) For Barrett's esophagus, continuing surveillance is a shared decision, and a patient who could not tolerate endoscopic, surgical or oncologic treatment should stop surveillance at any age (BPA 3 and 5). The AGA statements are expert-opinion Best Practice Advice without formal evidence grades, and they set no new numeric age or life-expectancy cutoffs. New alarm features (iron-deficiency anemia, GI bleeding, change in bowel habit, weight loss) still warrant diagnostic workup at any age; this is general practice, not a guideline statement.