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Health & Medicine for Senior Citizens

Many Colonoscopies for Older Adults May be Inappropriate, Study Says

Unnecessary screenings are almost 40% for those 76 to 85; 23.4% for all 70 and older. Second study finds seniors just keep on getting cancer screenings without results.

colon screeningMarch 11, 2013 – Almost 1 of every 4 colonoscopies performed in Medicare beneficiaries 70 years and older in 2008-2009 in Texas and across the country were potentially inappropriate according to age-based screening recommendations or the results of a previous screening.

A study by Kristin M. Sheffield, Ph.D., and colleagues of the University of Texas Medical Branch, Galveston, that analyzed Medicare claims data for Texas and a sample from the United States, revealed the problem in an Online First article today in the American Medical Association’s JAMA Internal Medicine.

The study background highlights increasing evidence of overuse of the procedure and that some Medicare patients with negative findings at screening colonoscopy may be undergoing another screening too early.

 

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Colonoscopy repeated within 10 years after negative screening results represents overuse based on current guidelines.  Screening colonoscopy performed in the oldest age groups may also represent overuse according to guidelines from the US Preventive Services Task Force (USPSTF) and the American College of Physicians.

The USPSTF recommends screening for colorectal cancer using fecal occult blood testing, sigmoidoscopy, or colonoscopy in adults, beginning at age 50 years and continuing until age 75 years.

The risks and benefits of these screening methods vary. The USPSTF recommends against routine screening for colorectal cancer in adults 76 to 85 years of age. There may be considerations that support colorectal cancer screening in an individual patient.

Older People Just Keep on Getting Cancer Screenings Even When Nothing Appears

In another Online First report by JAMA Internal Medicine it was found that many older people had never discussed ending cancer screenings with their doctor or considered stopping on their own.

An interview study by Alexia M. Torke, M.D., M.S., of the Indiana University Center for Aging Research, Indianapolis, and colleagues, sought to examine older adults’ perspectives on cancer screening cessation and their experiences communicating with physicians on the topic.

The study included 33 older adults (ranging in age from 63 to 91 years) presenting to a senior health center.

Undergoing screening tests was perceived by participants as “morally obligatory.”

For many of the older adults who were interviewed, stopping screening would be a major decision. Participants also indicated they were skeptical about the role of statistics and the recommendations of government panels in screening decisions, the results indicate.

 “Effective strategies to reduce non-beneficial screening may include discussion of the balance of risks and benefits, complications, or burdens,” the study concludes.

This work was funded by grants from the National Institute on Aging.

 The USPSTF recommends against screening for colorectal cancer in adults older than age 85 years.  The USPSTF concludes that the evidence is insufficient to assess the benefits and harms of computed tomographic colonography and fecal DNA testing as screening modalities for colorectal cancer.

The background on the study also reports complications from colonoscopy are more likely in people aged 75 years or older.

The study results show that 23.4 percent of all colonoscopies performed with patients age 70 or older in the Texas study were inappropriate.

Breaking the results down by age group shows inappropriate procedures in -
   9.9, in patients aged 70 to 75,
   38.8% in those 76 to 85, and
   24.9% in patients or 86 years or older.

There was considerable variation across the 797 colonoscopists in the percentages of colonoscopies performed that were potentially inappropriate.

Seventy three colonoscopists had percentages significantly above the mean (23.9%), ranging from 28.7% to 45.5%, and 119 had percentages significantly below the mean (23.9%), ranging from 6.7% to 18.6%.

The colonoscopists performing these procedures with percentages significantly above the mean were more likely to be surgeons, graduates of U.S. medical schools, medical school graduates before 1990, and higher-volume colonoscopists than those with percentages significantly below the mean.

Colonoscopist rankings were fairly stable over time (2006-2007 vs 2008-2009). There was also geographic variation across Texas and the United States, with percentages ranging from 13.3% to 34.9% in Texas and from 19.5% to 30.5% across the United States.

 “Inappropriate use of colonoscopy involves unnecessary risk for older patients and consumes resources that could be used more effectively,” the study concludes.

This research was supported by a grant from the Comparative Effectiveness Research on Cancer in Texas, Cancer Prevention and Research Institute of Texas; grants from the National Institutes of Health and the University of Texas Medical Branch Clinical and Translational Science Award.

 

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