Does First‐Time Colon Cancer Screening Beyond Age 75 Reduce Cancer Risk Without Significant Complications? Insights From a Large US Retrospective Study

ABSTRACT Introduction Colorectal cancer (CRC) is a leading cause of global cancer‐related morbidity and mortality. This study examines the impact of first‐time screening colonoscopy on CRC incidence in obese individuals aged 75 and older using a large US retrospective cohort. Methods Obese adults aged ≥ 75 were divided into two groups: those undergoing their first screening colonoscopy after 75 (Cases) and those without prior colonoscopy (Controls), using TrinetX database data. Results Propensity‐matched cohorts of 123,930 patients each showed reduced CRC incidence (0.08% vs. 0.52%; OR: 0.157, p < 0.001) and lower all‐cause mortality (9.6% vs. 17.3%; OR: 0.510, p < 0.001) in the colonoscopy group. The number needed to treat to prevent one CRC case was 227. Perforation rates were similar (0.2%, p = NS), but gastrointestinal bleeding was higher (5.2% vs. 4.4%; OR: 1.187, p < 0.001). Conclusion Screening colonoscopy after age 75 significantly reduces CRC incidence and mortality, with manageable complication rates.