Too Many Seniors Getting Colonoscopies?

Colonoscopy rates among seniors suggest overutilization

(RxWiki News) During Colorectal Cancer Awareness Month, we’ve been hearing about the vital importance of colorectal cancer screening. But some people may actually be getting screened too often.

A recently published review found that colonoscopy procedures for people aged 70 and over may not always be necessary.

Doctors may be overusing the screening in the Medicare population to the potential harm of these elderly patients.

"Colorectal cancer screening at age 50 is best."

The US Preventive Services Task Force (USPSTF) and the American College of Physicians recommend that screening for colorectal cancer begin at the age of 50 and continue until age 75.

For those with a family history of colon cancer, screening may start earlier. Routine screening is not recommended for those 76 to 85 years old and no screening is recommended for folks over the age of 85.

For colonoscopies, healthy individuals are screened every 10 years, up until age 75.

Kristin M. Sheffield, PhD, of the University of Texas Medical Branch, Galveston, and colleagues analyzed Medicare claims data for Texas between 2008 and 2009.

They also analyzed a 5 percent US sample of procedures performed between 2000 and 2009. A total of 168,080 records were reviewed.

The researchers deemed a colonoscopy as possibly inappropriate if it fell outside the age-based screening recommendation, or if it was performed too recently after a previous clear colonoscopy.

Overall, nearly a quarter (23.4 percent) of the colonoscopies performed on individuals 70 years of age and older were potentially inappropriate, the researchers reported.

The study looked at the procedures of individual colonoscopists (professionals who perform colonoscopies).

“The colonoscopists with percentages significantly above the mean were more likely to be surgeons, graduates of US medical schools, medical school graduates before 1990, and higher-volume colonoscopists than those with percentages significantly below the mean,” the authors wrote.

In addition to specific specialists, the authors found that various geographic regions saw an overuse of colonoscopies in the elderly.

“Inappropriate use of colonoscopy involves unnecessary risk for older patients and consumes resources that could be used more effectively,” the authors wrote. “Public education campaigns on appropriate screening colonoscopy may reduce unnecessary testing and increase available screening capacity for the at-risk population.”

Findings from this study appeared in the March 12 issue of JAMA Internal Medicine.

The research was supported by grants from the Comparative Effectiveness Research on Cancer in Texas, Cancer Prevention and Research Institute of Texas, the National Institutes of Health and the University of Texas Medical Branch Clinical and Translational Science Award. No conflicts of interest were disclosed.

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Review Date: 
March 11, 2013