Colorectal cancer screening and management in the aging society: a narrative review of benefit, risk, and the biological imperative for rural and community medicine

Objective

As the global population ages, colorectal cancer screening among elderly individuals has become an increasingly debated issue, particularly in resource-limited rural settings. This review aimed to synthesize the current evidence regarding the benefits and risks of screening in older cohorts to guide community practice. Materials and Methods: We critically analyzed the literature on fecal immunochemical testing, colonoscopy, and polypectomy, emphasizing the geriatric paradox, in which cancer risk peaks as physiological reserve declines. We compared the international and Japanese guidelines for the "10-year rule" and "lag time to benefit".