"Old classic cars" are hidden treasures: colorectal cancer screening should be considered in unscreened persons over age 75.

tal cancer screening be considered in elderly persons without previous screening? A cost-effectiveness analysis. Life expectancy and comorbidities are import factors in plan of a cancer screening. Colorectal cancer screening was shown to decrease the mortality of colorectal cancer (1,2). The U.S. Preventive Services Task Force recommends colorectal cancer screening beginning at age 50 years and continuing until age 75 (3). It did not recommend screening after 75 years for people who have been screened. It has not been clear if colon cancer screening is effective in older adults without previous screening. In the June 2014 issue of the Annals of Internal Medicine , van Hees and colleagues' study was published to understand the effectiveness and costs of colorectal cancer screening in persons older than 75 years without prior screening by using MISCAN Microsimulation Screening Analysis-Colon model (4). They simulated the effects of screening in persons with and without comorbid conditions in a cohort of 10 million previously unscreened people between ages of 76 to 90 years. People without previous screening were compared with those with previous screening as the life expectancy decreased with increasing age and with comor-bidities. They assessed the screening strategies of colonoscopy, sigmoidoscopy and fecal immunochemical testing. The model evaluated variables to estimate the quality-adjusted life-years gained or lost with screening. It was sensitive both to the benefits of screening when life expectancy is long and to the harms of screening when life expectancy is short and screening does not prolong life. Colorectal cancer screening with colonoscopy was efficient and cost-effective for many older persons who were unscreened so far. In persons without any comor-bid conditions, colonoscopy was most effective and cost-effective until age 83 years, sigmoidoscopy at age 84 years, and fecal immunochemical testing at age 86 years. In persons with moderate and severe comorbidi-ties, colonoscopy was indicated up to ages 80 and 77 years, sigmoidoscopy at 81 and 78 years, and fecal immu-nochemical testing at 83 and 80 years, respectively (4). This study has important implications. For most of older persons it used to be reasonable to withhold screening. The study is the first to look at benefits and cost-effectiveness of colorectal screening beyond age 75 years without previous screening. They showed that one-time screening seems to be efficient with acceptable costs up to age 86 years. Assuming there is a willingness to pay was $100,000 per quality-adjusted life-year gained in the study. Colonoscopy …