Few Dukes’ A lesions were found (1%). Routine screening of this cohort of patients older than 80 years with colonoscopy might have increased the likelihood of detecting early-stage curable carcinoma. Concern that older patients will have worse outcomes than younger patients following low anterior resection for rectal carcinoma is refuted by studies showing that older patients have similar numbers of bowel movements (2.5 per day) and similar rates of fecal urgency (34.9%) compared with younger patients.136 Colon cancer screening This issue is the focus of a separate report to the Future Trends Committee; therefore, this report will focus on issues of particular importance in geriatric patients. Gastroenterologists provide at least 60%–70% of all screening colonoscopies in the United States. The decision in 2003 to include colonoscopy performed every 10 years in low-risk patients as a cost-effective screening method for detection of colorectal cancer137, 138 has major implications for the gastroenterology workforce.139 The change in policy occurred as a result of review by several groups involved in monitoring and funding public health, including the Department of Health and Human Services, which co-coordinated funding of Medicare. Studies published in 2000 indicated an alarming rate of right-sided colonic neoplasms missed by conventional screening with flexible sigmoidoscopy and barium enema.140 They were performed primarily in patients in the younger geriatric age range (mean age, 60 ± 8 years); however, the results are likely applicable to older patients, because the incidence of colonic polyps and carcinomas increases with age. Older patients appear to have an increased risk of right-sided carcinomas141 and flat-type early lesions in the right colon that are more difficult to detect and remove.142 The issue of colorectal polyp screening in older patients was reviewed by Miller and Waye,143 who stressed the issue of using available data on expected life span when deciding whether to continue screening in older patients.144 Table 1, based on 1990 data, shows the expected years of life at ages 70–110 years (a 71-year-old person would have 15.3 years, a 115-year-old person would have ∼0.5 years). Recent demographic data indicates that average life span has increased by 2–3 years since 1990; thus, these values are underestimates. This has created a new dilemma as the population ages and life expectancy increases, namely when to stop screening. Current guidelines indicate that screening colonoscopy is appropriate every 10 years starting at 50 years of age, but gastroenterologists indicate anecdotally that they are not comfortable deciding when to recommend discontinuation of screening. Previous use of age cutoffs such as age older than 80 years as a discontinuation point are not likely to be well received by the future cohorts of “baby boom” individuals, because their average life span is already near or at 80 years. Colonoscopy can be performed safely in octogenarians.145 There is insufficient evidence at this time to determine whether an age cutoff for “polyp development” exists. Interim studies at 5 years in individuals found to be polyp- and cancer-free on initial colonoscopy performed after age 60 years indicate that this population appears to have a much lower rate of adenoma and colonic cancer than that expected in an unscreened or naive population.146, 147 These findings suggest that there may an age by which individuals could be designated as “nonpolyp