JAMA
Older adults with prior adenoma face higher CRC risk—but it’s dwarfed by other causes of death
Clinical Takeaway: For patients aged 75 and older, especially those with frailty or comorbidity, weigh surveillance colonoscopy after prior adenoma against substantially higher competing mortality and patient goals of care.
In a retrospective cohort study published in JAMA, investigators tracked colorectal cancer (CRC) incidence and mortality among 91,952 adults aged 75 years or older who’d undergone colonoscopy before age 75 within the US Veterans Affairs system. About 28% had an adenoma on prior colonoscopy; 72% did not.
Over 10 years of follow-up, adults with prior adenoma had a higher cumulative incidence of CRC than those without (1.1% vs. 0.7%; P<.001), and slightly higher CRC mortality (0.5% vs. 0.4%; P=.005). Despite these relative differences, absolute risks remained low in both groups.
By contrast, cumulative non–CRC mortality at 10 years ranged from 46.9% to 48.4% overall and climbed steeply with frailty. Among those with prior adenoma, non–CRC death ranged from 34.2% in nonfrail patients to 82.0% in those with severe frailty—far exceeding CRC risk at every frailty level.
“While prior adenoma modestly increases colorectal cancer risk, competing risks for death in older adults are far greater,” said corresponding author Samir Gupta, MD, MSCS, emphasizing that surveillance decisions should reflect overall health status and priorities.
Source: Gupta S, et al. (2026, April 9). JAMA. Colorectal Cancer and Mortality Risk Among Older Adults With vs Without Adenoma on Prior Colonoscopy