Colonoscopy Repeated Too Soon in Many Older Adults
Also, colorectal cancer screening burden lower in people with higher life expectancies
TUESDAY, May 10 (HealthDay News) -- Screening colonoscopy may be overused in average-risk older adults, and those with better life expectancies are less likely to experience a net burden from colorectal cancer screening and follow-up than those whose life expectancies are low, according to two articles published online May 9 in the Archives of Internal Medicine.
James S. Goodwin, M.D., of the University of Texas Medical Branch in Galveston, and colleagues evaluated data from 5 percent of Medicare enrollees to identify average-risk patients undergoing screening colonoscopy between 2000 and 2003 and to assess the timing of surveillance colonoscopy after a negative exam. Of the 24,071 patients who had a negative exam, 46.2 percent had a repeat exam within seven years, but in 42.5 percent of these, there was not a clear indication for the early repeated exam. The researchers concluded that a substantial proportion of Medicare patients undergo colonoscopy more often than current guidelines recommend.
Christine E. Kistler, M.D., of the University of North Carolina at Chapel Hill, and colleagues studied data on 212 patients aged 70 or older with a positive fecal occult blood test (FOBT) result to examine outcomes after seven years. They found that 56 percent had a follow-up colonoscopy, detecting 34 adenomas and six cancers; of those who did not have follow-up colonoscopy, three died of colorectal cancer within five years and 46 percent died of other causes within five years. A net burden from screening was experienced by 87, 70, and 65 percent of those with worst, average, and best life expectancy, respectively (P = .048 for trend).
"We demonstrated that older adults with substantial life expectancies were less likely to experience net burden than those with limited life expectancies," Kistler and colleagues conclude. "Therefore, through individualized decision making, the percentage of patients experiencing net burden could be decreased by better targeting FOBT screening and follow-up to healthy older adults."